Hello, and welcome to this video tutorial. In this video tutorial, we're going to cover logging into the Avocon virtual world for the very first time. To do that, we're going to use the Firestorm Viewer. There should be a Firestorm Viewer shortcut right on your desktop. Go ahead and double-click to open that. When Firestorm has started, you should see the Avocon Grid's home screen. You should also open provided with a username and a password. As you can see, there are several text boxes where you can place that information. The first text box is your avatar's name. In my case, that is Marcus Llewellyn, so I'm going to enter that now. You'll also have been given a password, so you'll want to enter that too. Once you've entered your name and your password, all you have to do is click the Login button. Once you've logged in and you're in World, one of the first things you're going to want to learn how to do is move around. The easiest way to do this is by using the arrow keys on your keyboard. The left arrow key will turn you left, and the right arrow key will turn you right. The up key will move you forward, and the down key will move you back. You can also use these in combination with each other, so you can move forward and turn left, or move backward and right. You should make sure to practice using these keys. Get used to how they work and how they feel. Make sure you can move around obstacles easily. Once you've gotten used to moving around in World, you're going to want to learn how to communicate with other people. If you look at the bottom of Reviewer, you're going to see a text box. Next to it is a nearby chat button. Anything you type in that text box is going to be seen by other people in World, so if I say hello, Joyce here is going to see that. And you can see the text pop up on the lower left-hand corner of your screen. When Joyce says hello back, it'll appear there too. If you want a more permanent way to see your chat, look at the toolbar at the bottom of your Viewer. One of the buttons is a conversation button and has a little quote icon on it. Let's go ahead and click that, and a new window pops up. You can see that our hellos are in there. I could ask her how she's doing, and she can answer back. And this is a more permanent way to chat. Now chatting this way, everybody around me for in a distance of about 20 meters can hear what we have to say. If I want to speak to Joyce privately, what I'm going to do is put my mouse cursor over Joyce's avatar. Right click and choose I am. You'll see in the chat window that a new tab has appeared with Joyce's name. Anything we type in this chat window will only be between Joyce and I. So, if I say hello to her here, nobody else can see that, just Joyce. And when Joyce replies, I'm the only one that can see that. Another way to communicate in world is with voice, just like on the telephone. If you have a good microphone and for your computer or in your laptop, you can talk to other people via voice. A good headset works too. As a matter of fact, that's preferred. If you have a headset, that's perfect. And as you can see in world right now, I have voice active. So you can see my lips are moving. You can see that there's a little white dot over my head, and that means voice is active. And as I talk, you can see wavy green lines coming off of me. If you look at your toolbar at the bottom, you'll see that one of them has a microphone. That's for voice chat. And there's a little checkbox. I have the microphone button already pushed and the checkbox on, which means that I'm constantly open. Everything I say, every noise in the room I'm in will be broadcast to the people around me in world.  And as you can see, my mouth is stopped moving and the green lines have gone away. So if I want Joyce to hear me again, I need to click on that microphone button. And now Joyce can hear me. And I can hear her too. She's on voice. Hi, Joyce. Hi, Marcus. How you doing? I'm doing well. Good to see you here. Yeah, good to see you too. And this is a really wonderful way to communicate online. It's for a lot of people, it can be much easier. Not everybody's as comfortable with chatting in text. So sometimes voice is a wonderful option if you have a good microphone or a good headset. One of the features of the viewer is called mouse look. It allows you to look at the world in a first person perspective. The easiest way to do this is by using the scroll wheel on your mouse. By scrolling up all the way, you will achieve a first person perspective. And by moving your mouse, you can look around. If you use the arrow keys, you can also move while you're looking around. To exit mouse look, you can just scroll back on your mouse wheel or press the escape key. Often you can interact with objects in world. That includes things like sitting on chairs.  And you can tell because the mouse cursor changes to a little chair when you hover over them.  In order to stand up, look for the little stand button down towards the bottom. Click on the stand button and you'll stand up. Another way to sit down is to right click, choose, sit here and you'll sit down. Again to stand up, just use the stand button. In a virtual world, you aren't limited to just walking around. You can also fly. In order to fly up, use your page up key. While you're flying, you can move around with the arrow keys. If you use page down, you will go lower. To stop flying, just look for the little stop flying button down on the bottom of your viewer. Click on it and you'll fall to the ground. Go ahead and practice flying. It's a lot of fun and a very quick and easy way to get around. To look around in world, there's more ways to do it than just moving your avatar. You can also move your camera. One way to do this is to look at the toolbar that's at the bottom of your viewer. You can see that you have a lot of buttons down here. The one we're looking for has an eye. That's the camera controls. Go ahead and click on it. A new panel will pop up. On the right side, you can pan your camera. And on the left side, you can orbit. Let's go ahead and try orbiting. And now let's try panning. To reset your camera's view, just click on the little X button. You can also click on the little person button to take a good look at your avatar. This is handy if you want to take a look at your outfit. You can use it with orbit. Make sure you look good and spiffy. The next icon is an over the shoulder view. And then the next one is the rear view, which is the normal one. The next icon will let you look at an object. If you click it, you'll notice that your mouse icon has turned into a magnifying glass. Let's say we want to look at this rock right here. We take our magnifying glass and we hold down our left mouse button. That becomes the focus of our camera. When we move our mouse with the left mouse button held down, we can look all around it. We can see it from every angle. And we can choose a different rock and look at that one too. We can use it to look at our avatar too. Or anything else in the world really. To reset your camera view, remember, just press the X. You can also use your keyboard and mouse to look around the world. By pressing the Alt key and holding it down, you get the hourglass. Hold your left mouse button and you can look at an object by moving the mouse around. Again, you can look at anything in the world this way. So if you need a closer look at a sign, you can just use your Alt key and your left mouse button. To reset your camera view using the keyboard, just press the Escape key. As you spend time in the world, you're definitely going to make friends. And you're going to want to keep track of those friends. And you can actually add people as friends in your viewer. If you look at your conversations window, you'll see that there's a Contact tab on the left. If you click that, another area will pop up and at the top you'll see you have a Friends tab. I have a few listed already, but I don't have Joyce as a friend. So if I right-click on Joyce's avatar, go over to Add, and then As Friend, you'll see a window pops up, offering friendship to Joyce Betancourt. I'm going to click OK, and that's going to send a friend request to Joyce. Now normally, Joyce would accept that friend request because she's a nice person, but she's going to refuse this one, because we want to see what it looks like when you get a friend request. So now, Joyce is going to send me a friend request, and as you can see, a little toast popped up, saying, would you be my friend from Joyce? I'm going to click Accept, and there are Joyce's in our friends list. Now that Joyce is in my list, I can talk to her anytime I want, no matter where she is. All I have to do is find her in my list, double-click under Name, and a private message window will pop up, and I can chat to Joyce in there. One final way to communicate online is via a group chat. Most people in the world belong to a group. In your case, you're going to belong to the CompuGirls group. You can see this in your conversations window, under Contacts, and under the Groups tab. If you move your mouse cursor over the CompuGirls group and double-click, a new conversation window will open. Anything you type in here will be seen by everybody who belongs to your group, and anybody in your group who talks back, like Joyce, you'll also see in that window. Everybody in the world has an inventory. You can see your inventory by going down to the toolbar at the bottom of your viewer and looking for the suitcase. First click on the suitcase to open our inventory. A new window will pop up, and we can see that it's filled with lots of folders. There are also three tabs at the top. The default one, Inventory, shows your complete inventory. The recent tab will show you everything you've picked up since you've logged on, and the Warn tab will show you everything that you're currently wearing. Some things in World are for sale. On this grid, everything's free. We don't have any money. But sometimes making things for sale is just the easiest way to give things to people. Sometimes you can tell if something is for sale because it will actually say it's for sale with a sign. Or if you hover your mouse over it, you might see this little icon up here, which is an L with a little dollar sign. Let's say you want to buy this question mark t-shirt. If we left click on it, we get a pop-up telling us what we're buying, in this case the question t-shirt. Let's go ahead and click the buy button. When you buy something, it goes into your inventory. We can look and see that we have a new folder called question mark t-shirt. If we open the folder, we can see the t-shirt right there. Let's wear this t-shirt. If we right click on the t-shirt and go down to where it says wear, it can take a little bit but you'll see that I've changed shirts. If I wanted to find this t-shirt later after I picked up lots of stuff and my inventory got very large, the easiest way is to use the filter. You can search for things in this text box at the top of your inventory window. We know that this is a question t-shirt, so if we type in question, everything in our inventory that has question in the name will show up. To clear this filter, just click the little X in the text box. Sometimes things that we buy in world come in a box. This is very common when what you're buying is a set of objects, maybe a complete outfit or a set of furniture. In this case, there's a box here that has three hats in it. Let's buy the box. We right click on it and choose buy. We get a pop up telling us that we're buying the CompuGirls hat box and what that box contains. We can see it contains three hats. Let's go ahead and buy it. If we look at our objects folder and open it up, we can see that we have the CompuGirls hat box, but now we need to get the hats out of the hat box. To do that, we need to do what's called resin. We need to take the hat box and make it appear in world so we can open it up. To do that, we click and hold our left mouse button on the CompuGirls hat box in our inventory. We drag it out into the world and then we let go of our left mouse button. As you can see, the box has now appeared in world. To open the box, we right click on it and then we choose open. We get a pop up telling us what we've just opened and we have the option to copy it to inventory. Let's go ahead and do that. Click on copy to inventory. Now you can see we have a new folder called CompuGirls hat box and if we open it up, we have some hats. Let's wear the top hat. Let's right click on it and choose wear. I already have a hat on, but now I also have a top hat on. If I want to take the top hat off and go over to my inventory, right click and select detach from yourself. You're going to want to remember to clean up after yourself when you open boxes. So don't just leave them. Make sure to right click on the box and take it back. That'll put it back in your inventory.  You could be a dog or a cat. You could be a robot. You could even be a talking garbage can if you'd like. One of the things you can do is customize the way that your avatar is shaped. You can see I have a stocky guy. I could make changes to that though by right clicking on my avatar and choosing appearance and then edit shape. I get a new window and the camera has moved so that I can see my avatar in a pose. There's all kinds of sliders we can change. I can change how tall or short I am, how thin or thick I am, maybe I saw fat or thin. And I can change a lot of different body parts. My head, my eyes, my ears, nose, mouth, chin, torso and legs. Let's play with my ears a little bit. Let's make them really big and using the slider make the ears really pointy. There. Now I have really big elf ears. If I wanted to keep this change, I could use the save as button. I don't want to keep this so I'm going to use undo changes and that snaps everything back to the way it was. When I'm finished editing my shape, I can just close the appearance window. You'll probably want to practice with this. There are so many possibilities and it can take a quite a long time for you to find a look that you really really like.  All you have to do is click them and buy them. And you can see we now have three professional women outfits in our inventory. Let's say I want to be professional woman number two. All I have to do is right click on that folder and choose replace current outfit. It may take a few seconds, but soon you'll change into that outfit. You can also mix and match. Let's say I don't like these pants. I want darker pants like professional woman one had. So let's go looking for professional woman ones pants. Let's see there they are. And I right click and choose where. Let's say that I've decided that that's an outfit I want to keep. If you look at your toolbar at the bottom, there's a button that has a t-shirt on it. Let's click that. This brings up an appearance window and it'll save all of the outfits that you've created. So if you want to save this one, all we have to do is do save as and let's name this one professional woman two mix. We can also use the appearance window to change our outfits.  So if I choose that one and wear it, I'll change into that tiny little mouse. And if I want to go back to being the outfit that I created, I can click on that one. Choose where. I know I'm back to being that woman. When I'm done, I can just close the appearance window. And that concludes this video tutorial. Remember that the CompiGirls region has an orientation area so you can go through it at any time to refresh yourself if you need to learn some of these skills again. Thank you very much for watching and we hope you find it helpful.


This is how I get ready for a ride on my e-bike as an amputee. When I lost my leg, I kind of thought that outdoor biking was off the table for me. I was really scared of going long distances, having prosthetic issues getting stuck. It was also really uncomfortable on my prosthetic, but there are two things that allow me to ride again. Number one is this new leg. It's cut down further in the back. It's specifically for biking. It allows me a full range of motion so I can actually pedal. And the second piece of the puzzle is that I got an electric bike from Red Power Bikes. You can see it behind me. It's absolutely adorable, but way more than that, it allows me to bike outside for long rides again. This e-bike has pedal systems, I can determine how much I want it to help me pedal. It also has the throttle. So the fairy used to have a biking somewhere and running into prosthetic issues, not being able to get back home safely is completely gone. I feel confident going for 10, 50 mile bike rides on this thing. It's really enjoyable. Also, if I don't really want to pedal a lot or sweat, I can just kind of enjoy it with usually bike rides. It's amazing to be able to bike outside again and I'm really grateful for it.


Hello again, everyone, and welcome to another edition of Yes, We're Here. I'm Jack Curry, and today I'm delighted to be joined by friend, colleague, but most importantly in this scenario, co-author of Full Count, David Cohn, and, David, we're celebrating an anniversary. It's been a year since this book came out, so happy Full Count anniversary.  I gave you a lot more credit. Co-authors is being very generous in my mind. You did Yeoman's work trying to bring all this together over the years, and a lot of great stuff in this book, and I think it's weathered pretty well over the year. Jack felt pretty proud of the efforts that we both put into it. I did want to ask you a couple of questions before we get to some fan questions. We did 42 interviews, and I'm not lying when I say to you that every time we finished an interview, whether it was face-to-face, over the phone, even an email or a text, I would say to my wife, Pamela, man, I just learned so much about pitching. This is going to be so good. I can't wait to get this in the book. This was a personal journey for you. You were kind of opening up some veins and telling me all those stories. When those interviews were done, what were you thinking in that immediate moment? Yeah, it's almost as if when you relive those moments, a lot of times you can fill in the blanks and things that you forgot about, and then the stories become much more clear, and certainly the circumstances and the events that lead up to a certain chapter in the book really kind of jogged my memory. I'm sure that's the case with a lot of people that go back over their careers and try to remember certain stories. So yeah, I was really surprised. One thing would lead to the other, as you know, Jack, and then I'd go off into a different rabbit hole, and well, if we're going to go down this rabbit hole, then we've got to explain things a little bit. Just one thing led to another, and it really felt like it was kind of raw at times and came from the heart in directions that I didn't think either one of us anticipated happening. You did an interview, actually we did it together, where you said it started out as a pitching journey and it became a personal journey, and I totally agree with that. Two quick anecdotes I wanted to share with you. I gave a copy of this book to Garrett Cole in Spring Training, and we know how intelligent a pitcher he is, and he made my year, and I told him this, when the next day he came up to me and said, I've read four chapters, I can't put it down. You guys did such a great job. That's the first anecdote. And then the second one was, when you had your 20 year anniversary of the perfect game event in Manhattan last summer, your dad came up to me and said, I just want to let you know, I know every step of my son's career. I know everything that he endured. And within this book, you captured his voice. I felt as if David wrote every word. And that was the other stamp of approval. I said, Mr. Cohn, please don't say anything more than that. You've just made my night. Yeah, I know, and of all people, that would be Eddie Cohn. Eddie Cohn would definitely know every step of the way. Ed and Joan Cohn, I talk about him a lot to you, Jack. I talk a lot about them on the air whenever I get a chance. Joan Cohn, the sabre nutrition and the scorekeeper. And of course, Eddie Cohn's style of coaching. So yeah, he would know. And he said that to me as well. I think some of those stories helped him relive some of those events of the past. So I threw this out on social media, and I was happy I got a lot of feedback. So I picked some of the best questions. And I said to folks, ask David a question about pitching about the book. And Fred Feb said, you guys mentioned fans in the stands in the book, like David's family and the Cohn heads. When David was in the moment, could you feel the fans rooting for you or against you, and what kind of edge or disadvantage did that give you? Yeah, I definitely felt it, Jack. And I learned early on in my Met's career. And a lot of it had to do with Andrew Levy, who I didn't know at the time, who now runs my foundation. But he was up in Shea Stadium with Cohn heads on. And it became kind of a national phenomenon, at least it was shown on the news highlights. And the next thing you know, you started to look for them. And you know, you felt it. And then the crowd got into it. So from an early point in my career, I realized how much foresight that the New York baseball fans had. You know, they anticipated the flow of the game. When you got two strikes on a hitter and you got on a run, you know, they started to chant for strikeouts. So I fed on that really my whole career. And it's really a lesson I learned from my early Met's days. Julian G, I met this young man at the Winter Meetings and aspiring sports journalist. He wants to know what was the most difficult part of maintaining your perfect game?  And that's when that's when doubt kind of sets in. That's when you start, you know, I described as the good angel and the bad angel, you have positive and negative thoughts. And the more dead time you have, and the less people you have to actually talk to because of superstition, the more those kind of thoughts are prone to creep into your head. So I had a lot of that going on. So I think that was probably the toughest part. It was just the mental battle of battling the anxiety, fighting off the negative thoughts and just trying to have tunnel vision and simplify your thoughts and narrow your focus, I think is the challenge really for any athlete. We've got an interloper here, Justin Shackle. This guy's a pro. He's been on the Yes Network. We see him at Yankee Stadium, but Justin's a very talented young man. And he said throughout the book, David always talked about different ways to get hitters out. Justin wants to know what new age approach would you like to try if you were still pitching today? You know, I would love the numbers.  I see like every pitching coach is an expert in biomechanics or at least putting together a laboratory for pitchers to be evaluated. You know, it's like a golfer getting fitted for clubs. You have a launch monitor, they measure your swing speed, your launch angle, the spin rate on your ball. I would love all that stuff with my pitching because that's how you design pitches, Jack. You could actually take spin off of a splitter and get, you know, and kind of tinker with your splitter and get immediate feedback based on the analytics that you're getting and, you know, the spin rate models that you can get on any pitch you throw. Curveball, sliders, variation between pitches. I think you can have all that measured so much more accurately nowadays that you can really design pitches off of each other now.  And that's my wheelhouse, spinning a baseball, being creative, you know, developing new looks and new pitches. I think I would be enamored with that analytic ability nowadays. Kristen Alexander, David, she wants to know what coach or teammate helped you most get back in the zone after a mound meeting? No, once again, I got to go back to the early days, because I think you're more influenceable when you're a younger player or a rookie or your first couple of years in the big leagues. But for me, it was Keith Hernandez, you know, he was at first base and he would just bark at me. It could be a one or two word statement that he'd make at me or yell to me on the mound. It would just snap me right in, right into it. Or he'd actually come to the mound and say, look who's on deck, anticipate the flow, you know, and don't give it to this guy. It's okay if you walk this guy, don't let this guy beat you. He just, he made you think one step ahead, you know, constantly. And that was a great lesson to learn when you were young. Yusuke Shirakata, very active on Twitter.   Pedro Martinez had a great changeup, although it was almost a screwball the way it had action on it and had fading action.  That'd be the one thing I'd really wish that I could have developed. David, I'm going to close it out with Buzzsaw191 and I think I'm actually going to handle this one. He writes, I learned more about pitching in baseball than any other baseball book I've read. Awesome read. How come this book wasn't written sooner? So I'm going to say, I didn't ask David early enough. And then once we did do it, I kind of wrote slowly. We wanted to make sure it was perfect. I think we got it to a point where we were really happy with it. As we close this out, David, I absolutely want to thank David Black, Sean Desmond, family members like my wife, Pamela, anybody you want to throw a shout out to that helped make sure that this became a reality. And by the way, this is only staying up for the interview. I don't think that that's up there all the time.  It's pretty good right there. Send it my way. I'll put it on my wall afterwards. Now this book doesn't get, this book doesn't happen without you, Jack. You're the, you were the impetus behind it. You pushed it, you made it, you saw it through. We've known each other for so long that we had such a great working relationship right from the start. Andrew Levy obviously did some help behind the scenes and still does to this day. But yeah, all the names you mentioned, Jack, as well as you, this is really a tribute to you. And you know what, it was because of your efforts that it cracked the New York Times bestseller list the first week out. Connie, it's always great to catch up with you. I look forward to seeing you in a ballpark or a booth sometime soon. Absolutely. Good talking to you.


So, in this presentation, we will be talking about some principles of governance and we have proposed a three-way governance model, which is based on a past experience of how we can manage and govern successful DHHS implementations in countries. And we follow a proposed structure which a country can implement who are managing their implementations. And then we'll have a look at one of the examples of systems evaluation, which is the DHHS to majority assessment toolkit, which has recently been used in many countries to assess their existing DHHS to implementations. So, we have the presentation plus we'll have two mentee activities. So, please keep your devices ready so that you can log in into the mentee questionnaire and answer those questions and we'll take those responses as we move ahead. So, we'll be covering the proposed three-layer governance mechanism for sustainable DHHS to systems. Just a cautionary note that this is not something that we're saying has to be there when you are managing your DHHS implementations. This is a proposed model which has been developed based on the past experiences that we've had working with the ministries of health and what could be a potential model of governance which could be administered in a country with different people working in different levels with different skill sets. They can be arranged so that you have a national core team of DHHS to which is guided by a central committee, which comprises of higher ministries, etc. We look at the three groups that we proposed that should be formed in order to kind of have lay the foundation for a sustainable DHHS to information system. The governance committee, the DHHS to operations management team and the DHHS to core technical team and we'll see what are the proposed skill set and the quantity of resources and their key responsibilities that we're talking about. So, learning objectives are we would like to understand why clear governance and coordination of canons was important to sustain the implementations as a long-term investment and what are the three levels or the governance structure that we're trying to propose and what are the competencies which are required at each level so that when we go back we can take this as a guiding tool and start implementing these interventions that we're proposing or if you already have these structures in place then how can we better refine those responsibilities so that we have something which can work as a well-oiled machine as we go ahead. So, I'll share the code and the QR code for the Mentimeter. We have one very basic question for you to answer before we go ahead. So, you can log into menti.com and enter the code 5641746 or you can scan the QR code. So, I'll just show the question. The code is 5641746. Okay. So, we just have a very basic questions for you. Governance, what does this word mean to you in the context of information systems? So, it's a free text question. Please feel, try to put few keywords which you think define governance when it comes to information systems. So, as you put your answers, we'll quickly review them before we go ahead further in the presentation. So, we have some responses, sustainability, yes, decision-making, regulations, commitment to lead and manage the vision, agree to our understanding of management, laws and policies, yes, set of policies, decision-making, data management, multi-sectoral coordination, yes, very much, organizational management, framework, policy and structure, management body to support DHS implementations, training, sustainability, policy management, yes. So, we have a variety of keywords that understanding is more or less aligned to what we wanted to propose as what is governance. So, thank you for your responses. So, I'll just move ahead. So, we like to discuss about some, why proper governance is crucial to a sustainable DHS to systems. We're looking at clear governance and coordination mechanisms because they're critical inputs to enable that DHS to work as an integrated health information system in our countries. Now, we're working in a multi-sectoral environment in the country where we have different health programs running. We have HIV, TB, malaria, IDSR, RNN, and CS. So, it's a combination of programs and health services which a country is providing to its citizens and all of them bring their own complexity and their own priorities when it comes to designing information systems. So, we need to have a platform where all these conflicting priorities could be brought up, could be discussed and decisions could be made on those priorities. And that means that you have multiple stakeholders across the Ministry of Health and the national health programs which need to have one joint operating body which can discuss these priorities and help in making decisions based on the priorities which are of more importance than the others. Okay, because everything is important when it comes to health but still things need to be prioritized and have to be given a defined order so that we don't miss upon certain opportunities which could be taken for a certain disease health program. And then we need an operational system that supports the need of different levels in the health systems. Now, we're working at different levels in the health hierarchy. We're working in the community. We're going up to the district level. We're going up to the state level and going up to the country level. At each level, we monitor different indicators. So, the complexity increases when we go up the hierarchy. Therefore, we have to take note of all the nuances which happen at each level. Therefore, this governance should take care of the decisions or the indicators or the data that comes from each level and how that data is contributing to larger indicators, the coverage indicators, the performance indicators of the country. Therefore, governance is clearly very important when it comes to the essential design of your information system and how it can be put into a better shape so that it produces the outputs which it is meant to produce. What we propose is a three-layer governance model which is a recommendation which kind of should have three basic functions where we should have a well coordinated prioritization process which is led by say the top level, which is your governance committee, which is a multi-sectoral group of people who can discuss the priorities of different health programs and can come to decisions to decide what would be the strategy, what would be the timeline of certain health information systems implementation and kind of build a larger roadmap or the HIA strategy in country. Similar to what's happening in Sri Lanka and other countries where they're developing their digital health blueprints that is being led by a governance committee who is looking at the priorities of different sectors and how these health programs can work together and these the information systems can be built which can take care of multiple programs at once. Then at the very high level we're having a lot of decision making happening but we need a team who can operationalize those decisions therefore we recommend having a strong operation management team which can guide the minor details of the work to the people who will actually do the technical implementation and then we have a dedicated technical team who will actually carry out your DHS to configuration implementation and capacity building. So it's a three-layer structure that we're trying to recommend based on the past experience that you had that we should have a governance committee which should have stakeholders for multiple ministries, multiple programs, health programs which should make the overall blueprint of DHS to in country which is followed by the operations management team who is basically trying to find approaches to convert those decisions into actionable items and then we have the technical team which will basically carry out the DHS to configuration and your capacity building implementation plus technical support towards managing what has been built in country for implementation. So let's look at the the essential criteria which needs to be followed for the governance committee that we it should have a cross ministry committee where the key health information stakeholders across the ministries can are part of that specific committee so that their inputs are taken when you're deciding the overall strategy for health information system design and they need to take all the strategic decisions when it comes to defining the scope of DHS to. So when we start working with these countries we initially try to identify a group of people who will be the key information stakeholders which will define that what will be the essential scope of DHS to when we start it in the country and essentially how the scale up will be planned. So this group should have members from all the important ministries all the important health programs so that we have opinions coming in from everyone and we can define a joint work plan for execution and we also recommend having representatives from all the major health programs in country. We recommend that the governance committee should have both tech the members should have both technical and public leadership. So we should have members who have rich experience of working in public health interventions plus they also have experience in implementing technology solutions so that they can combine both the aspects of health and technology together so that these areas are not left untouched because ultimately both these areas are important for any successful DHS implementation. And then we need a clear mandate and a continuous meeting cycle so that continuous directions are given to the operations management team. So it's not a one-off meeting that you met once to design your work plan and you forget about it you need to keep on meeting on a frequent basis so that the updates that have happened so far can be analyzed critically and corrective actions could be made and the operations management team could be given further directions on how to deal with certain situations or how to plan ahead which they can further take up with the technical team in country to actually implement the decisions that we take. Then we have the DHS to operational management team who are basically responsible for implementing the priorities and plans which are set out by the governing committee. So the key decisions have been taken now it's time to define approaches to bringing those decisions into actual actionable items. So we recommend having a DHS to lead or a DHS to manager who can work with the security manager in place where they can be responsible for the overall ownership of the DHS to system and be responsible for managing the long-term sustainability of the system. So the DHS to operation lead is a sort of full-time position that we recommend that should be part of the country's operational team but the security manager can be a larger with a person with a larger umbrella of health plus other systems are in country because security is an overarching field which has impact on health and other technical information systems as well for other areas also. So he could play a supportive role for health information systems as well but DHS to operationally should be a full-time responsibility where he can put his 100% effort on materializing the decisions which have been taken by the governance committee. So the operational lead should work closely with the technical team so that he can provide he or she can provide clear guidance and plans are in place so that the actionable items are well executed and are tested well and then are implemented as we go ahead as per the project activities and the project plans. Next we come to the DHS to core technical team these people will be responsible for day-to-day technical activities and for maintenance of the system therefore we need to clearly define some standard operating procedures for the technical team in terms of what operations they need to take on their health information systems and how they plan to execute the activities which are defined by the DHS to operations team. So we recommend an optimal size of around four to six people which will comprise of your configuration and maintenance aspects. So our administration data security and the people can play a dual role of configuration maintenance plus they can also carry out capacity building activities as and when needed and generally we recommend following our train the trainer method so where you could do you can create master users within the within your ministry and the public health workforce working in districts and they can further train do cascade trainings in country to provide further capacity building to the other members working at the health facility. So the server administration and data security are overarching positions so they could be working for other departments at the ministries as well on their information systems so we can have share these resources for health information systems as well. When it comes to building DHS to capacities of course these there's no specific educational qualifications required to be a DHS to expert but a generic understanding of IT databases and information systems is required and these DHS to skills can be improved can be taken in from the academies from the online academies the courses which already available free of cost for all the users plus they can also attend the DHS to academies organized in different regions and countries on different thematic areas at regular intervals so that are the source of building for the capacities in your on your DHS to skill set. If the person has some public health knowledge that is definitely useful because ultimately we're looking at public health audience and public health data collection so some knowledge and public health would be helpful for him to understand the entire landscape of why the information system is being built what is the importance of data that is being collected and how is that data being used when the forms and everything are defined in within the information system. Ideally we recommend that the team should be part of the ministry so that they have an ownership of the work that they're doing but in certain circumstances the ministry cannot hire such a big team so the team could be external but the sustainability is a recommendation that they should have long term contracts so that they do not leave after short term assignments and it's difficult to track people and if you run into certain issues then many times you've seen that ministry struggle to provide long term contracts to consultants or the team members so the idea is when you are designing your annual work plans you're putting your country funding cycles to request to Global Fund Gavi and other donor agencies make sure you plan your DHS to teams in advance and you put in enough money for supporting long term DHS to teams in country which work as part of the ministry of health and then they can be further supported by the his groups working in your region in training and building capacities of the internal team at ministry of health so that we build a sustainable relationship between his the ministry of health and the health information systems that we're trying to build. So the summary of the proposed governance model is given here where we recommend that if this model is adopted or recommendations are taken in our existing structure what has been discussed here would help you in terms of building this coordination as a long term process and you'll see gradual improvements happening over the course of your DHS implementation. The ministries where these positions are not yet defined if these positions then they'll need to be defined as new positions and there'll be some specific problems when it comes to recruitment finding the right persons but overall this if this approach is followed then you'll be able to implement a long term capacity building plan and because you need to identify people and if you identify people then the next work is to make sure that their capacities are built in association with his groups and DHS to academies and then these people can be sustained over time to ensure that they're able to perform their job well within the health information system team. So we need to ensure that we follow the main principles of coordination system management and we will need to lay out some SOPs in place so that we have clear definitions of what role each person each position has to perform and what are the expectations from that person and if you can define some eligibility criteria then that would be helpful in making the selections and we have in the previous slides we have some guidances which are available which are industry standards like obitoga these are enterprise architecture standards which are not specifically for health systems but they can be applied to health systems as well plus the uio team is frequently updating documents and releasing guidance documents as we learn more from the community and from the country implementations they continue to release documentation on guidances of how you can sustain the health information systems over a longer period with the proposed strategies that could be implemented and be shared with the team that you put into place. So before I go ahead with the systems evaluation piece giving one example of DHS to maturity profile with any questions that the participants would like to ask then we could discuss before we go ahead. So thank you for the presentation it's a really comprehensive guide on to how can establish the DHS to the country. So my question is that yes if we are talking about the central and risk of health how to operate it how to implement DHS to the region of your coordination mechanism but when we come down to the pro-clad reference meaning that like HIV, TB or surveillance or mother, mother and child do we still need to have these three layer applied for them for example TB need also the omalaya need also have the government committee or they also need operational management or they also need a team or not. Thank you. Thank you Dr. Chanthi. So we're not recommending having repetitive structure within each health program because that will be difficult to coordinate plus manage in terms of financial resources available. So we're looking at an overarching team which can be which can take considerations requirements priorities from each national health program separately and given the list of priorities that national health programs bring then the governance committee can decide that which program priorities have to be taken first when they design overall timeline and work plan for HIS scale up in country. So we definitely do not recommend that you should have separate structure for each of the health programs but we recommend having more of a overarching structure which can be part of which can take care of needs of all the health programs which are running in the country. That's why when we recommended the governance committee these mentioned that it should include all the relevant ministries plus all the major health programs should be part of the governing committee so that they can understand the needs of each health program and make conscious decisions and then the team involved can implement that work plan based on the priorities that was set by the governance committee. I hope that answers your question. Any more questions? Yes. Okay thank you for the opportunity. Maybe I will share in Deka Ijaparta implementations to success the use of the HIS to to manage our data. We create obligations such as like a policy to force everyone in the district health office, provincial health office or government health facility to enter the data, to use the data, to use the HIS to platform to manage the data but and then for the mores we create performance indicators of the use the HIS to use the data in the dashboard to analyze the data and also to enter the data and to make the integrations between health facility to us to district health office and provincial health office if but if we create penalties such as like the penalty if you don't want to enter the data if you report the data late etc. I will cut off your salary I will cut off your salary every month and I think the regulation the policy it works so the the use of the the HIS to in this years is very success in Deka Ijaparta so I think we need not to strengthen the facility human research and etc so we need the policy we need regulations obligations to force best on my counter-regulation I think you can adapt in your country thank you thank you so yeah definitely you make a very good point that regulations are equally important yes we mentioned about more on the having a layered governance structure and the operational and a technical people but yes at the end of the day you need to have standard operating procedures at each level which determine your cutoff dates for data entry your data quality checks your data locking periods so that SOPs which can be decided by the governance community that these are the deadlines that you want to set for reporting which are then implemented by the operations technical team so this way I think it's a good example of these decisions were already taken at a very high level and then now comes a time that they're implemented and these are giving you results in terms of better reporting rates and timeliness rates so that's definitely a good example of how these decisions were taken and these decisions are now converted into actionable items which include your reporting protocols that I said so thank you for sharing your observations this time thank you for your presentation I want just to make sure that I have understood what we have presented and the country level we need first like a staring committee or a high level committee which is multi-sectorial dealing with all the aspects of DHIS2 in the country yes underneath it should be a technical committee which will be specialized in all aspects of DHIS2 and in all of these we need to have SOPs so that will organize the work okay so up to this moment I am going out so my question is this the case in all the countries no sir so the this was not the case in the countries that's why we came up with this approach that why information systems are not running on a longer sustainable basis because of lack of these committees in place so the experience that we have had over the years in terms of managing these country implementations we based on those learnings we have kind of we are defining or recommending that this structure if it can be implemented by a ministry of health then gradually they'll see those improvements happening in the processes in the design of the system and the implementation so and the whole concept of suggesting this came from the failures and the challenges that we saw in these countries that that were facing issues with DHIS2 implementations so not all the countries are doing it that's why we're recommending that though those who have such similar structures in place can strengthen them more by following these guidelines and those who do not have these such structures can go back and start working on setting up these structures in country to support their DHIS2 implementations and the evaluation comes from the committee the high committee yes yeah so we'll talk about the evaluation so the decision to carry out these evaluations understanding the results of the evaluation and then making decisions to correct the findings of the evaluation those will come from the governance committee thank you very much yeah sure thank you very much it's clear right now that you have brought a structure of three levels for the governor's committee I mean this structure is not just limited to the DHIS2 implemented systems but it probably will affect other projects and other systems that are dealing with information we also need clarifications about how to involve other committees I'm sorry other parties governmental parties who are involved in the information sector not just the health information sector but in general in this committee in the governor's committee and explain what kind of coordination that should be you know in this area yeah you understand me is very much correct this is not limited to only DHIS2 but when talking about a more digital system strategy in country it may include all in other information systems as well including the DHIS2 so this structure reform can help you to have a overall overarching information system design governance committee so it may include other health systems also coming to setting this up of course this needs much more communication and direction to be given say from the minister of health to other ministries say interior affairs or information technology ministry to come together to build a platform where we can join forces build expertise together and create a common committee where they could discuss all the areas which relate to data and information needs but then I think we can also utilize the donors who are active in the region to build on this help you building this coordination because when it comes to financial support and when donors push for a more joint intersectoral plan or a joint coordination plan the ministries tend to listen and they they kind of agree to work together when they when the donors also give a push that this needs to be a more integrated activity rather than just minister of health or minister of IT defining things what should be the digital health blueprint in a country so I think there are many ways where you could also enforce internal communication but if you need support from the donors then we can of course they can be reached out and the communication channel the challenges could be discussed and they could be one of the instrumenting factors who can help you in bringing people on board and kind of working towards a more integrated approach so in the assessment please that will cover we'll see why we design the maturity assessment toolkit to kind of show the donors a joint combined picture of the HIS assessment in country so that many donors could come together and then they could also influence the ministries and their focal points to come together to build a stronger steering committee in a country so sir I would like to add some something from the Nepal we are in Nepal we are implementing two things for the better DHS to especially in reporting system first one is for the government the government health facility who are reporting in ours DHS system they are motivated by themselves and we use when they are rewarding the health facility we take one indicator who fulfill the DHS to reporting in on time that is also one indicator for the motivation and the reward for that health facility in local level, provincial level and central level and in the annual review or final review we can give them reward for that that completing DHS to reporting in time similarly for the private sector we have one rules for them if they didn't did the DHS to reporting in our platform they would not register or renew in our system that's the clause so we can do better in the information system otherwise private sector is very hard to come in our system they have on system and they don't want to collaborate in our government system for the information so that that is the clue when they come for registration or the renewal they must submit and the monthly report in the DHS to platform after that only they get their renewal of that health facility so that is also good for our regular recording and reporting in sustainable way thank you thank you yes I mean Nepal has a unique system where they have governments at different levels who are able to manage their challenges and priorities internally as well so they have these LGDs they're working at the board in the municipality level then they have districts and then they have provinces so I think they've implemented a very good model where they have these committees at the smaller levels as well so that all the initial issues can be taken care of by the municipality committee and then only the escalations that happen when you need help from the provincial or district health offices to intervene and provide solutions so that's a very good example of a bottom to top approach for decision making and management so thank you for sharing that so I think we have around 16 minutes so I'll quickly review the maturity profile so DHS to maturity profile toolkit is basically an assessment framework which was developed along with the coordination with the global fund team and the team at University of Oslo to try and assess the maturity of a DHS to implementation over certain important factors which we'll see in detail and comprising of your aggregate implementations your tracker implementations and targeting P disease programs HIV TB malaria immunization surveillance and any other program if you want to assess the maturity of in terms of system use data use availability of HR infrastructure etc etc so we'll quickly see how this assessment was carried out in few countries and what were the outcomes that we saw and how it can be used by other countries as well to assess the maturity of their implementations so I'm sorry the font is a little small but then there's no fixed recipe to have a mature DHS implementation but then when we talk about information systems there are three pillars that are essentially required one is people the other is process and third is technology people who already identified in the first presentation that we need to have these layered model and each layer has a specific set of people to work with they should have defined roles and responsibility so I'll not go into more details process we already defined that as mentioned by the members from Indonesia and Nepal that they have good processes to measure the data quality they're good processes to ensure data use and they have SOPs and routine reviews being carried out so that takes care of the process and technology is of course infrastructure and infrastructure needs a lot of all three of these need a lot of investment but then infrastructure also needs investment so that when your DHS to implementation scale up they are backed by a strong infrastructure so that you don't have technology challenges in scaling up your DHS to solutions and even the technology needs to be continuously assessed so that any gaps identified can be fulfilled moving forward through financial support from donors to other mechanisms available as well so the whole purpose behind designing the DHS to maturity profile was to have a mechanism to measure the progress of the health systems strengthening over time so this is not designed to be a one-time process it is designed to be a continuous process that every year or every year you carry out assessment and then you see the change of what was the situation a year before and with the inputs that have gone in both technical and financial inputs that have gone in what has been the improvement over time it tries to identify the areas which need more strengthening so that your investments or your request to donors are going in the right direction and the donors can also see that these are the key areas where the country is not performing so well and is not at the advocate level as it should be so the funds have a clear direction that the fund should go to that specific activity so we'll see how these scoring sudden how we come up with the conclusion of the maturity profile and then once you have this picture they kind of tell you very clearly and what areas which help programs which foundational activities the country is performing well and where it is not performing well so that the donors can see and identify that what are the areas that they can support it's a good reflection of your country's existing situation and giving the donors a good view of what's happening right now and what are the areas that you want financial support to strengthen more so they also have clear information available to decide the direction of their investments so if you see the difference between the two images that are shown here which are based on fictional data so you have country one and country two you'll see for country one they have performed well when it comes to core team for DHS to maintenance they have good quality metadata for DHS to they have good level of training for end users they have data collection set up for facility and population profile and their infrastructure needs are well taken care of so their foundational activities are more or less acceptable so they are doing well in terms of pacing their information system scale up but when you compare with country two you'll see a lot of foundational areas are in early progress they haven't reached the uh educator mature level so therefore you see that country two needs more investment in terms of forming up their foundational areas because if the foundation is weak and it applies to all these things that we build if it's a house or something you need to have a strong foundation so we house is equivalent to building your information system in country if it has a weak foundation then there are many chances that you'll face challenges of scale up challenges of implementation challenges with the user capacity therefore when these assessment questions are answered it grades your responses and gives you a final outcome that these are the areas which are at this level at present so that you can highlight that these are the activities these are the programs which need more support and you can make a strong case to the donors that these are the areas where we need more help so that they can direct the funds accordingly okay so in through this uh tool you can assess the maturity of your DHS to implementation in country it measures and helps you understand how is the country progressing on the health system strengthening and it kind of summarizes beyond the activities of course when you design a health system you the basic activities will definitely will put into place because you're defined processes for that but then overall how the system is performing uh in terms of the level of maturity that it can come that can be measured through this respective assessment as it gives a good reflection of the uh the legends the criteria that has been set up both in terms of their maturity level and their implementation scale also so we're looking at uh that the particular intervention for DHS to either aggregate or tracker can be in development could be in a pilot stage or has been scaled up to a country level so that also is assessed when the the questions are being evaluated and answered for the toolkit so the whole idea behind building this toolkit was to get a clear cut picture of where your DHS to uh implementation stands in terms of maturity so that the investments could be uh uh sent through in the right direction where they are required special focus was given to the foundational areas because they were the ones in the countries that we assess we found that the foundational areas were either early progress or they were not yet achieved and mostly we found that the country's lack uh they have early progress on either leadership of governance or strategy investment they are no clear work plans no joint work plans being made and we saw that a lot of countries were struggling with their core team for DHS to maintenance with their capacities so when global fund used these profiles for deciding what areas they like to fund they made sure the funds go to foundational areas first so they help countries to build uh provide its financial support to the his groups to create to do more capacity building activities for the selected countries to ensure that they have a core team with strong DHS to skills they invested in upgrading the DHS to versions so that the people can use the latest DHS to features and they also helped in assessment of metadata to kind of improve the quality of metadata which also affects the the data in the system so the whole idea is that through this tool you can align your investments and your daughter interventions very clearly because you have a clear picture and it will help you in assisting your DHS to implementation and sending activities if you carry out this assessment on a regular interval before any fund cycle you're doing for any donor if you can do a reflection of these status then it helps you to identify your bottlenecks and you can direct your funding request based on resolving those specific bottlenecks which are identified so i think this i've already covered yeah so the tools that the tool captures three core areas of DHS to implementation the tracker aggregate and foundational foundational is at the bottom because it's it's the more most important aspects which need to be taken care into account so we are looking at legislation governance security infrastructure as the and the capacity as the foundational areas we are looking at the aggregate data collection by different health programs and then we move up to tracker and we're moving up in the way the complexity increases so you need to have foundations clear you need to have the aggregate data collection but then tracker is more complicated so it's at the top because you take time to switch from your aggregate reporting to case post reporting to mature over a period of time okay so the recommendations that we have for aggregate systems when you're trying to enhance your DHS to aggregate programs make sure that your foundational areas are at least early progress your people have basic skill sets available to enter data into DHS to use the basic data which they're entering and you have early capacity within your HMIS team to manage the daily incoming requests and understanding the whole information system how it has been built and how it operates in the country okay so if you have weak foundational areas and you're planning to further scale up your aggregate interventions so that the recommendation is to focus more on the foundational aspects first and then plan the scale up when it comes to the aggregate aggregate the expansion so if your foundation topics are not yet achieved make a priority that these need to be achieved first before you enhance your data collection and you scale up your program horizontally and vertically in terms of both content and your scope of data collection tracker is always much complicated because you're dealing with individual records so when you are planning to start a tracker program it is a complex endeavor because you're you need a large investment in infrastructure if you are you want data to be captured at the point of care you need to have laptops or desktops or mobile apps available mobiles available with the service provider to collect data therefore it needs a lot of planning to estimate the infrastructure the capacity and the skills which are required to use tracker in country therefore you need to have first of all the institution buy-in from the key stakeholders that would be a governance committee so when a governance committee is convinced that you have enough resources to implement tracker in a country then only move forward towards tracker implementation funding again is very important because aggregate systems scale up much faster as compared to tracker systems therefore tracker systems will need much more funding support and tracker is requires much more capacity building much more refresher trainings for people to understand the complexities of case-based reporting because when they're reporting case-based data data quality again is of key importance so aggregate data quality is also important but tracker data quality is much more important and take much more efforts to improve the case-based reporting the capacity has to be there in terms of not only for people to use the system but also the people to design the system and maintain the system over long term so that should be taken into account here since we're talking about patient records we need to ensure that we only collect vital information in your trackers which contribute to indicators because if you design long forms collect all sort of information which is not relevant to your key indicators and your increase in the workload for your health workers so those decisions have to be taken into account before you are planning your tracker implementations so in general the foundational domains have to be at a minimum acceptable level when it comes to trackers so if any of your foundational domain is at early progress then we need to hold and make these foundational domains go a level up and then proceed with your tracker implementations and since we're dealing with patient data so data security and privacy is of key concern therefore if you're implementing tracker implement if you're doing tracker programs and make sure your DHS security compliance is at least at advocate level so that you have defined data sharing and data protection protocols so that these the data is not misused because it has personal identifier information as well and whether your program wants to collect personal identifier information or not then that is also a decision you need to make before you implement your tracker programs in country. Then the last recommendation is to focus on continuous improvements so as with aggregate systems the planning and budgeting is very important and is more complex when it comes to tracker because it needs more investments so you need to continuously evaluate the performance of your tracker systems and make conscious decisions that where your funds need to go which could be on infrastructure and capacity building so we've seen a very good case in nipple for the HIV tracker implementation that a big focus was only given to system design and implementation but when they actually went to the facility and asked the ART council that what value add you see in this system they say we don't see any value add you are doubled our work we are maintaining paper registers we're maintaining digital copies also so then the whole funding went to data use activities where they showed them that how the system can help you identify patients who have missed their appointments and haven't come back for ART pickups so when they saw that this system is solving a lot of their manual work then the adoption increased many folds in country so these decisions can only be taken when you do a very a continuous assessment of the implementations that you're doing so that you can define a good direction to our implementations as you want so thank you for your patience listening I it was a long session but I hope it was useful for your in-country implementations if there are any questions we have around two minutes we can take a couple of questions and then we can go on thank you sir for this the saving of this very useful tool so in epitri we are implementing this attacker almost in 18 countries from the tobacco program and also in aggregate so it will be helpful for us if we get this tool to assess our system so can we get this tool yeah yeah it's free for mostly it's targeted for an overall assessment but if you want to only focus on the HIV tracker data collection and the parameters on which we assess a tracker implementation we can of course share the tool with you on the tool and assess the focus on the HIV program as well yes okay so thank you actually my very small question regarding the last point you mentioned to take care of the tracker security because when we start when we offered some life TB program and other programs to use tracker they said no we are not sure whether this data is secured or not so can you please elaborate more and about this point exactly how can we persuade them to use to use it or to give them at least to assure them that the data is secured and no one can see it yeah sure sir so your data security over the years has been a very critical working area for us at DHIS too and also at the Ministry of Hospitality and they've invested a lot of resources and expertise in terms of building guidance around security in DHIS too so there are many ways in which you can maintain the security one is of course at the system level how you provide accesses to the stakeholders who have access to the system so setting up clear sharing settings between users and users so that only the TB program personnel can have access to the TB data and that too if they only can access the aggregated information the dashboards and the indicators and they don't have access to individual patient records that levels have to be defined and shared with them that these are the mechanisms that we'll set up so that any other stakeholder who has access to the Libyan DHIS too but has no access to TB then he cannot access the TB data by any means then we have other mechanisms at the infrastructure level where you can set up security protocols or at your service where to kind of prevent any sort of attacks on your on your infrastructure so we have a session we have we'll be having Michael who is the security lead at the Ministry of Hospitality based center and he will be sharing more information on the measures of security and what improvements the DHIS to team is bringing in terms of guidance so we'll definitely you'll get more information on managing the security risk within DHIS so one thing I want to supplement this one for example in Bangladesh there is a country regulation if you want to implement any system that should be passed the security audit so there is a country security audit policy so if you want to implement a DHIS to instance so there will be a security audit by our Ministry of ICT so they have one specific unit they can test the system and satisfy this there is no security hold or something so that's the requirement so our all DHIS to instance is our security audit yeah so I think a similar requirement is in India as well so whenever you're doing a any information system for a state government it has to go a generic security audit and that report has to be submitted to the government only then they allow the implementation and hosting of the system at their data centers so that's one of the protocols that are put into place by many companies any more questions so since this was our last session so we are closing the sessions for the day as directed by Dr. Pomod we will be leaving for a social event at 6.30 so please be in the lobby by 6.30 a.m for the transport to take you to the venue and I hope you enjoyed the day and look forward to tomorrow thank you so much