Well, thanks Sally for such a very warm and kind introduction and I have to say it really gives me great pleasure to join you here at Stanford today and I really want to thank Sally and the whole team at Stanford for the invitation and really for this conference as well because you are covering the key issues of our time. We've seen great political progress as we've already heard over the last year in addressing climate change and I also want to really recognise the work of Ambassador to Vienna who played such a leading role last year at La Borge in helping us as a world come together to drive a new global climate agreement. As she outlined this morning the agreement will be formally adopted this week which she didn't say but is faster than many had predicted it would be adopted and it will help guide us in the emissions reductions and deep decarbonisation necessary to ensure our planet's path towards a sustainable future. Deep price decreases in renewable energy technologies again as we've heard somewhat this morning especially in solar PV over the last years particularly since 2010 when combined with makes sense regulatory policy have already accelerated widespread adoption of renewables not only solar PV but also wind energy. And indeed last year in 2015 according to the International Energy Agency renewables surpass coal to become the largest source of global electricity capacity. Globally around 500,000 solar panels were installed every day in 2015 and this year we've seen some records setting low prices per kilowatt hour at auction for solar PV and onshore wind. According to Bloomberg New Energy Finance grid tide project agreements have gone as low as 4.0 per kilowatt hour in Peru in February, 2.99 per kilowatt hour for solar PV in May in Dubai and 3.0 per kilowatt hour bid for several wind projects by NL Green Power in Morocco earlier this year as well. Now those were all several months ago so by now they may already have been surpassed. But the key question that I want to focus on is can the market go everywhere is it enough and particularly for developing economies we cannot only measure progress from the standpoint of rapid price decreases for large scale grid tide renewable energy projects providing additional generation capacity into an existing grid although progress in that is extremely important. In some countries a large number and sometimes the majority of citizens don't even yet have basic access to electricity. So in terms of the deficit India actually has the largest number of people something over 300 million and statistics vary but about 300 million people living without access to electricity. Although their current government is very much prioritising action on access with some very aggressive targets that they're really trying to within the next few years actually bring about universal electrification in India and I'll come back to that shortly. And over 600 million people across Sub-Saharan Africa do also don't have any electricity. In this hemisphere we're doing better the situation is much more advanced but still even here in the Americas about 30 million people don't have access to electricity in their homes and communities. For example in some parts of Peru and other Andean countries in some parts of southern Mexico even and one that's near and dear to my heart because I've worked there many times over the years is in Haiti which actually has the lowest rate of electrification. Now some of you may be familiar with these figures but globally over 1.1 billion people around the world still don't have any electricity and another billion have only intermittent access. And over and above that some 2.9 billion we were hearing about clean fuels this morning but some 2.9 billion people don't have access to clean modern cooking fuels. So it's a double whammy you may not have the electricity and you also may be relying and dependent on traditional biomass for your cooking as well. So this limits economic development opportunities for the citizenry for those countries both national and local levels and I just want to say for a moment that when we talk about energy access it can mean different things to different people. When we talk about it with governments it often they're thinking about industrialization they're thinking about macroeconomic benefits they're thinking about how they can bring more electricity on to existing grid and really help support industrial development and that's absolutely appropriate. However when I'm talking about energy access most generally I'm talking about it from a human development standpoint in terms of what can be done with power. Traditional measures of grid extension really don't also focus on issues around affordability reliability quality of the services provided and so some of the newest ways of measuring energy access actually do bring these in and the World Bank. You can look it up afterwards but the World Bank has what's called a global tracking framework where they're really looking at tiers of service for energy access for households and communities. So this leads me on to the second area of great progress in the last 18 months which is the adoption by UN member states of 17 sustainable development goals. These replace the prior millennium development goals and the new goals and targets set out a universal framework for international action on development from now until 2030. What is especially notable is that while climate change is included as its own goal for the first time there is also a specific goal on energy and believe me this was not easy to get included in there. For those of you who may have followed the millennium development goals a lot of people said that the energy issues were kind of the missing millennium development goal. So politically it was a great win to be able to get goal number seven which largely adopts the language of the UN Secretary General's sustainable energy for all initiative to secure sustainable energy for all and focuses on energy access efficiency and the deployment of renewable energy with a view to reaching universal access to modern energy services by 2030. And Secretary General Bankimoon has really been a tremendous leader in this area in helping to drive the political momentum needed to be able to get this goal in place. And interestingly there is also recognition that it's not only a goal about energy but it's about a goal on energy as it enables other areas of development as well and I'll touch on that in just a moment. So there's now clear recognition by policy makers of the development benefits brought by having modern energy access, electrical power, modern cooking and also heating technologies and fuels. And governments both donor governments and developing country governments have adopted specific initiatives to address this although I would say that some need to move further and faster. Here as Sally mentioned in the introduction in the US we've really had great leadership through the President Obama's Power Africa initiative which was launched in 2013 with a goal of 60 million new electricity connections and 30,000 megawatts of new and cleaner power generation. So it's not all renewables it does include natural gas as well but it also includes a specific off grid component called beyond the grid that I was very much supportive of within the overall initiative that recognised that grid is not necessarily going to get us to where we need to go by itself. In developing countries Bangladesh is a great example of leadership where the government some years ago established a special infrastructure funding agency called IDCOL which supports the deployment of solar home systems through the use of partial cost subsidies and they work with an identified and agreed upon provider network around the deployment of these small systems which are bundled with solar PV, basic lighting. I think the last I knew maybe they've gone to colour now but it used to be a black and white TV and other small appliances for unelectrified households. By the end of 2014 more than three and a half million households across Bangladesh had installed these solar home systems so that's been a terrific example of a developing country that has adopted an off grid solution as part of their suite of solutions for energy access. But as I already mentioned change is not happening everywhere fast enough for the more than billion people who lack energy access. Many do still depend on expensive and I'm sorry to say it for the speaker who was saying about how fantastic fossil fuels are but for a household it really is an inferior energy support when that is providing your lighting inside your house because of the emissions, not only but also because of the black carbon emissions that contribute to indoor air pollution and they use candles or kerosene to light their homes in the evening. One of the other challenges as well is according to researchers a key source of poisoning for under five year old children is actually the ingestion of kerosene because if you think about it it sort of looks like a soft drink and so unfortunately it's a big poisoning challenge. Not only that but several years ago when I was in Haiti I visited a pediatric ward in a rural hospital and it was heartbreaking because 80% of the children who were hospitalized there were there as a result of burns. Some of them very extensive over their bodies from fires that had been caused by knocked over kerosene lanterns and candles. And unfortunately these very human costs of energy poverty are often really not included in the health care budgets or recognized fully as being something that requires immediate action within a health care setting because for a $10 solar lantern you could actually be reducing a whole lot of hospitalizations and health care costs down the pike. Equally in some countries women going to the clinic to give birth such as in parts of Malawi are still told to bring a candle with them to help light the birthing centre at night because they lack electricity. The childbirth of course does not wait until morning. You can't tell a woman to wait to go into labour until she arrives at the district hospital several hours drive away and for a surgeon to perform an emergency C section at night clearly also requires power. So the delivery of modern health care services particularly and I'm giving this as an example which is in sustainable development goal number three just to touch on how energy really equates with other development benefits. It just can't simply wait for the grid to arrive. So so rather than just saying OK well these people don't have the grid that's just too bad we've really been looking at what are the solutions that can be provided either instead of or before the grid arrives. And so research has shown in order for us to be able to reach universal electrification by 2030 which is the global goal that about 40% of the solution will come from some sort of grid extension. But the IEA says that about 60% of the solution will come from off grid solutions which includes either standalone solutions like solar home systems at the household level or some kind of pico micro or mini grid. But that that that may be interoperable with the national grid or it may be installed on a standalone basis. And clearly renewables are very very appropriate in these situations. Some micro grids are hybridized so it can be solar PV with a wind turbine in this case this one is in in Cacabilla in the blue lagoon area of eastern Nicaragua in an indigenous mosquito Indian community. And that wind turbine was powering the health clinic as well as a few households. But but in some cases diesel is is used in a hybrid situation with renewables but increasingly we're seeing renewables really leading in this area. So PV particularly is helpful combined with storage as well as policy and financing innovations and it's really driving a revolution over the last 10 years in the provision of off grid energy services. And so solar PV is especially useful in a healthcare context because it can be installed very rapidly and flexibly into frontline health clinics with lower operating costs and diesel generators. Even though the diesel gen set the capex is is quite low you still have to be able to purchase the fuel. And we found even in some health care centers that got diesel generators from the US government to help address the need for rapid new clinics to deal with the Ebola crisis. So it's a lot of deployment of diesel gen sets two years ago. Now some of those same clinics the ones that are still going have struggled we've seen to keep purchasing the fuel on an ongoing basis. So in the past the solar the capex was more expensive but you don't have such high operating costs and that has really been a bit of a game changer for some of these communities. And the World Health Organization has also done studies comparing solar PV solutions in health clinics compared with diesel gen sets and they've actually said that solar has a better performance overall as well. And they're cleaner so clearly from a WHO perspective they would rather see us producing fewer emissions particularly in a healthcare setting. An American surgeon I met in Freetown in Sierra Leone who was working in an up country clinic told me that his own staff were very skeptical initially about putting in a solar system for their clinic because it was located in an area unserved by the national utility. But then they did some research and really looked at the data when they catalogue results following installation. And the data showed a steep drop in the following months in maternal and neonatal mortality so mothers in their newborns resulting from being able to provide life saving surgery in the hours from dusk until dawn. So system sizes in these clinics will range from about 1 to 10 kilowatts on average usually AC. So you've got a system sometimes in multiple rooms across the clinic but also really focusing on the birthing area as well in a birthing clinic. One group here in the bay area that some of you may be familiar called We Care Solar also provides a small plug and play solution that doesn't provide solar PV for the whole clinic but does certainly provide the lighting and several solutions that are required during the birthing process. And that has been able to be deployed to a lot of clinics that are in off-grid areas and particularly actually is a humanitarian solution as well. For example in Nepal after the earthquake there last year. So the adoption of SDG7 on energy and I give the example of health but I could also talk to you for half an hour here about agriculture or about water or about many different areas that are affected by not having sufficient access to electricity. And having electricity also helps people to make a living because they can operate small businesses and it opens up opportunities for them that were not previously available. So I already touched upon solar home systems earlier and traditionally they were financed using bank credit and that really is a sea change going on right now in terms of the provision of solar using solar home systems. In the past the challenge was that first of all they were unaffordable if you were poor about 10 years ago it was about $600 for a small scale solar home system and as we've heard the cost of the PV have decreased but you still have the challenges around the cost of battery around the whole system integration making sure that once you've installed the system who's going to maintain it, making sure you have the whole supply chain in place for that. So this is a solar system in Karnataka in India put in place by Selco and here the consumer generally speaking has to provide a down payment and so if you're very poor the banks are not going to lend to you because they require a 20% down payment and you may not have that saved up. So there have been different ways to address that in the past. India has a tremendous tradition of agricultural bank lending so you can get the credit but they've used donor money in the past to bridge the bank loan and offsetting it with what was required by the consumer to be able to afford the initial down payment and then get the loan which generally speaking needs to be about three to five years long in order to be able to make the payments affordable for the household. So Selco has done this very successfully over 20 years. They've been a leader and a real pioneer globally and so you could say well that's the end of the story but in fact what we've seen just coming in the last really four to five years has been a sea change in terms of social entrepreneurs starting including one in particular but several have come out of the Bay Area providing a different type of financing and so it's really not a technology issue that we're talking about. Financing has been a key constraint because of the affordability issue. So two organisations I quickly want to touch upon. Before we come back to solar home systems I just want to touch briefly also on the story that started 10 years ago here at Stanford University and I was here in June and mentioned this very briefly but in a Stanford design class called I think it was designed for the base of the pyramid a grad student back in late 2006 I think maybe even early 2007 gave me a call when I was at good energies and said I'm starting this company focusing on small scale solar lighting because I found that in fact kerosene isn't good, candles aren't good and we want to provide something that's really affordable to the very poor and that company which came out of Stanford design class from the son of a Peace Corps volunteer his parents were with the Peace Corps so had travelled around and seen some of the energy issues in developing economies and then brought that back with him to his grad school class so that company is Delight which is leading solar lantern provider which provides very small entry level solutions a lot of these are a watt, two watts so but combined with LED and lithium ion or now actually more lithium ion phosphate batteries they provide entry level lighting at a price point which is way lower than a solar home system so the entry level now fast forward Delight has sold millions now of solar lights alongside other companies like Greenlight Planet which sells award winning lights with cell phone charging capability because people want the cell phone chargers as well as the lighting now last year Delight had a new entry level light that is affordable at five US dollars and they have researched and said that that was really the five dollar price point was really sort of they believed the barrier to then mass adoption and we're seeing very low cost battery powered LED lights coming out of China now and what we're really looking to do is say okay they break unfortunately very quickly so the quality of these solar lanterns has gone up enormously and to my mind a five dollar solar lantern should be in every child's backpack so UN agencies that provide these nice little backpacks for kids going to school with notebooks and things as far as I'm concerned they should also every single one now contain a little solar light so that the children are able to read at night and do their homework if they want to another area since my husband's in the audience and he's a humanitarian I need to touch upon briefly as well just very quickly the humanitarian consequences which is that these portable solutions are especially useful during humanitarian emergencies like the earthquake in Nepal like the earthquake six years ago in Haiti where I worked to get the first solar lights into the displacement counts because people were living in tents and when you have lots of tents very close to one another people living side by side unfortunately the risk of fire is multiplied so being able to provide non open flame solutions for their lighting purposes while they were displaced was absolutely critical as well as solar lighting for the camps to make sure that women and girls were secure as well so I'm just going to move on very quickly and come back to pay as you go assistance because this is where I would say I hate to use the word game changer in the bay area because I think sometimes it is overused but pay as you go is sort of taking the sector by storm now because what they've been able to do is really look at the combination of Solar City and Uber for the off-grid sector which is that they've looked at okay through surveys how much a household is willing to pay maybe you're paying $5, $10, $15 per month for your kerosene for your candles for the same price they are providing you energy as a service in some companies you are still over time purchasing the asset in others they're saying okay you don't have to sort of like a nano utility you don't actually have to own the asset what we want to provide you is the services from the energy system and one of the backbone changes that has taken place to enable this has not actually been an energy innovation but has really been on the cell phone side of the house through the adoption of mobile money and in Kenya there's a mobile money provider called M-Pesa which really provided the infrastructure for people to be able to use their cell phone to pay for small amounts of energy service so these companies like some of the leaders are off-grid electric and Nancy Fund who is going to be speaking with you tomorrow is one of the investors in off-grid so she may be able to tell you a little bit more about that Mobisol, Mcopa and some others as well have been really working and Kenya is a leading country for this approach to provide these small scale solutions now from a business perspective traditionally again the renewable energy provider provided the technology the bank provided the financing the difference this time is in one sense it's riskier because the renewable energy provider let's say it's a Mobisol or an Mcopa is providing the asset or the use of the asset but they're also taking the risk on their own balance sheet what they are hoping to do and what the investor community is trying to support them to do is then actually offsetting that risk by putting it back into the financial markets and we're still very early stage in this and I have to say this with some trepidation having lived through the real estate collapse in 2008 you know we want to make sure that in fact if there is securitisation of these assets that it is a solid opportunity for the financial markets to take on but there have been some encouraging signs a company called Bebox had the first securitisation just under a year ago in this market so it really has been looking at affordability and if you think about it when you have a customer who has a limited ability to pay you need to make sure that every what that you're providing to them or every service is really affordable for them and in a quality way because they can't afford to pay more than once if I buy a flashlight it doesn't work I buy another flashlight in their case if they're only making $1.50 $2 $3 per day that really is not an affordable equation or solution for them so that is an area that is extremely exciting and the story has not finished it's ongoing and as I say it's really a story of the last three to four years Kenya is a leader, Uganda, Tanzania, Rwanda is becoming a leader not every country has adopted mobile money so in some countries they're using scratch cards where you can actually get a code and put it into your cell phone to then pay for your electricity so the system stops working if you run out of juice but then you can either text or get a code for your cell phone and then you can add more onto your system so that really has been a sea change for the provision of energy services for off-grid communities and then before I conclude the other area where there's a lot of focus has been on microgrids and I would say this is also an evolving area the solar lanterns were a volume play that was done largely absent government regulation because it's a consumer product so you still have the import duties and so on but actually in terms of the deployment it was just like any other purchase so the home systems often also very loose government regulation when we get to microgrids however the story becomes a lot more complicated from a regulatory standpoint because in some countries it's a national utility that still has a monopoly microgrids may or may not legally actually be able to deliver power to their consumers so there's a lot of interest in this and I say microgrid it can be anything from a pico grid like a devigy provides in Tanzania that is really still providing very low amounts of power to consumers because that's what they can afford at this point alongside efficient appliances and I mustn't leave that part out because we are seeing some super efficient appliances now that can deliver a 15 inch LED TV that's only about 12, 15 watts so we can do a lot more with a small amount of watts than we could even five years ago and DOE has had a marvellous program called the Global Lighting and Energy Access Partnership part of the Clean Energy Ministerial they have competitions every year that has really showcased some of the leading super efficient TVs, lights and then this last year fans as well to show what you can now do even if you have very severe constraints on your energy system so just to wrap up with the microgrids we are seeing change we are seeing governments now more aggressively including different types of off grid and mini grid solutions in their energy planning there are some wrinkles for example if the regulatory structure is not really very clear for investors they are not really going to want to invest in a micro grid solution because what happens if the grid then comes to that community and you've invested in the micro grid do you just lose the value of the asset or is it incorporated into the national grid which is fine if it's interoperable with the main grid or are the investors compensated for the loss of the revenue so there's a lot of wrinkles that are still being worked out and at the same time though there's much more increasing awareness and appreciation of the role that these off grid solutions are able to play in terms of helping to address energy access and I just want to quickly that's D-Lights lantern but I just really want to end by looking at a little bit where we're going in the future because I think I talk at these conferences and it's all about catch up and it's about we're nowhere near where you are in the US let alone here in the Bay Area but in some areas they're actually ahead so I want to say that Rwanda has already started its first drone service to be able to provide medical samples, blood samples to get them to labs for testing very rapidly Mobisol, one of the companies that I mentioned also has been exploring the use of solar powered drones I know Amazon.com here is still thinking about it so it's not always about catch up sometimes it is about leapfrogging not necessarily leapfrogging the grid but really leapfrogging on the delivery of the service so I want to just throw out a little challenge to the students who are in the room because I have over the last six years had the pleasure of working with five Stanford grad students through what was then called the MAP Fellows Programme it's now called the Schneider Fellows Programme and I have a 40% track record of the five students who I worked with two of them actually then subsequently when they graduated from Stanford went into working on energy access issues one of them who went to work for a micro grid startup in Indonesia and the other Shea Hughes who is now working with off grid electric so it's a 40% track record I would love to see it maybe Sally too at a 60% or 80% but that fellowship really was instrumental for me in terms of helping our work at the UN Foundation get going in developing a lot of this programming over the last six years so I'll finish then thank you all for listening and I'm happy to take any questions so questions okay we've got one over here to go back to your first slide in the statement by Ban Ki-moon what's the energy, what's the power needed for a typical water pump? that's a great question because it partly depends on how deep they're pumping the water from so one of the challenges has been that solar water pumps tend not to be able to go as deep as diesel pumps so they were not always seen to be as usable by farmers particularly in agricultural settings in India but however one of the challenges has been that diesel has been drawing so much water that sometimes it's more than the farmers need and it contributes to lowering of the water table so I'm not not answering your question but I'm answering it in a slightly different way because one of the exciting things in India is that the government has really focused on initiative on bringing solar water pumping much more across the country and they've not only been able to do it to provide the limited amounts of water that the farmers need but they've begun to use it as a source of revenue for some of those farmers because they're able to then provide any excess power provided by the solar panel for that water pump to use it for other services so that's brand new and we're still seeing how that plays out but really trying to look at revenue for those farmers more questions, do we have one over there? Hi, thanks for your presentation I know this question is about solar cook tops and displacement of the kerosene with solar cook tops and I know that ideas have been kicking around for at least five years maybe longer I'm sure and based on my understanding the micro funding model is sort of a gating factor for the proliferation of those solar cook tops and we're still not seeing adoption at the levels that we want primarily because of that factor but it seems at the same time with respect to COP 21 and the need for developing countries to get funding that there needs to be more emphasis just on providing these funding rather than finding a way for people to come up with $15 or $20 a month to be able to do this because of the impact of kerosene even impacts the glacial melt in the Himalayas and whatnot your thoughts on how we could better enable that I agree with you, a lot of the pricing now is really reflecting what customers are already paying so it's complex because if the grid is coming then some governments do provide a lifeline tariff for the very poor so it gives them a certain number of kilowatt hours on a monthly basis others will subsidize a grid connection there's been a lot of discussion about this is it really ethical for consumers to have to pick up the cost they're already among the very poorest and a lot of the companies are really coming at entering it with very much a social mission as well as a commercial mission I would say the commercial often trails the social they came out as a social entrepreneur but they're also trying to make money doing it so I would say yes clearly money is an issue and we do recognize depending on whose analysis you follow we need an order of it's like nine billion dollars a year on energy access and we need to have several multiples of that to be able to provide full access but again it depends on whether you're talking about grid or whether you're talking about some kind of off grid solution with some of the very low income consumers they may not be able to afford more energy then a light and a cell phone charger initially so they have in the past and one of the reasons I actually moved over from the non-profit sector to the private equity sector and then on the policy side was that a lot of the giveaways in the past hadn't actually been very successful of solar home systems and these solutions Indonesia in the late 90s had given away about a million solar home systems but the challenge was that they hadn't really worked through all of the supply chain issues in terms of the maintenance of those solutions so coming at it from a full market standpoint at least we hope bakes in the ongoing maintenance of that solution so you have back to back warranties you make sure you've got professional technicians who are providing service you increasingly have call centres now we're seeing particularly with some of these pay as you go solutions that you have remote monitoring capability in the actual system itself so if for some reason you see that the production is going down it may be as simple as texting someone to say have you wiped off your panel recently but I completely agree with you on the cooking side that has been a real challenge partly because well first of all people are culturally very attuned to cooking in a certain way for the types of food that they're used to eating second is that word and biomass have been and continue to be the standard in terms of what's available and what's affordable for very poor communities I've done some work recently with an LPG group that's the global LPG partnership that are really looking at the provision of LPG which you may say well it's a fossil solution however it is looking at providing LPG in developing countries more broadly to help with reducing deforestation issues and it's a clean burning fuel so it also helps lower the indoor air pollution as well for that household in terms of cooking induction stoes would be interesting and maybe this is a great Stanford research project because we've struggled as an industry as a sector to really look at a fully renewable cooking solution so perhaps somebody will patent that in the next few years and we can really take it and run with it and help it to get adopted OK, right down there wait for the mic, there's one right behind you Have you faced any problems with regard to the financial infrastructure in countries like India because even the banks that do provide loans for agricultural communities they fail pretty often and even when the nabard rescues them it's like they go under very often and how do you overcome the problem of the financial infrastructure to be in place for the agricultural communities? Well, I can speak really to Salko's work which is that they've worked with many of the agricultural banks but what they've done and I think very successfully is they've also had banker to banker training because in Connecticut they've been there for 20 years people are used to financing solar home systems and solar for small scale community purposes as well in some of the other states they're less familiar with that and so they may be a resistance because they say well, I'm not really sure about this solar thing so they've done quite a lot of banker to banker training taking bankers from Connecticut to Bihar and I was involved with that a couple of years ago I'm really talking about best practices in lending in this sector now there are low interest rates so it is actually I think it's a 4% interest rate it's quite attractive in many senses but the other challenge has not been so much about the banks but in terms of a sort of forced subsidy which is that the government has put subsidies into the system but they haven't always arrived in time so for a small company you may actually be struggling in terms of your cash position because you've been selling the systems but the subsidy hasn't actually made it back down to you in time and I know there's been quite a lot of work in the last year and a half on improving that and making sure that the company doesn't go under by being too successful at selling the subsidized systems Okay, do we have another question? Okay, there's one over there Actually we're going to go over here because I think you've asked a question before and I'm trying to spread around so we'll go to you and then I'm going to ask one quick question at the end So I need to move to elsewhere in the room if I want to ask another question Just kidding Is any effort being made to enable the manufacture and service of these products be within country or is it just having them import these being manufactured somewhere else and serviced remotely from elsewhere in the world? That's a great question and I would say yes and no A number of years ago when I was still on the private equity side we were actually looking and saying well wouldn't it be great if we had some of these solar panel manufacturing facilities in West Africa because then we could do local production There's been a bit of a chicken and egg which is if you don't have power then you need the power to be able to produce the power so that's been a constraint for some countries which is that it just didn't really have the infrastructure to be able to have that manufacturing in country Second is as we've heard it's really a China play now I mean First Solar is one of the few non-China companies that has been able to be successful over a longer term until now So the costs have come down so much that while some governments are saying we really should be getting in this game and producing it locally I think on the assembly side the components and the system integration absolutely but in terms of the solar panels it's commoditised now so I don't really think from a cost perspective that there's necessarily going to be any additional value What we have been looking at though is really trying to support the local economy in the sales in the sales piece of the whole supply chain which is a number of groups have been particularly looking at women entrepreneurs and sort of like the Avon model which is a local community women entrepreneurs selling a suite of solar and cooking products to their particular communities either as a main source of income or as a supplementary source of income and so I think that's more is sort of looking at that local economic development and building that local entrepreneurship is the way that the sector has been moving more than really trying to say we're going to try and compete head on with the Chinese because I just don't see that that would be viable at this stage Last question for me When we think about energy access electricity always comes up and clean cooking fuels come up but what about mobility access because in many parts of the world you still see animals being used as a primary mode of transport that brings a whole set of challenges and so is there much thought on mobility access as part of this larger set of issues around energy access As our distinguished speaker from GM was speaking this morning I was thinking exactly that so why don't we get a lift or an Uber that can service some of these remote communities because if you're paying for the service rather than paying for the asset then it becomes much more affordable but it tends to be an urban infrastructure rather than a rural because of the dispersion of some of the communities but I think it's a great question and in some countries they are already looking at this in terms of the EVs for public transportation so I know Kenya, I believe in Nairobi they're beginning to replace their existing metatus which are the mini buses that are the public transport in the city with electric metatus in some parts of Asia I believe that there are electric rickshaws that there is work I haven't personally been so involved in the transportation solutions but you're absolutely right and there needs to be a lot of additional work on that area and hopefully GM can help us lead on that Okay so you've heard lots of challenges for the students so anyway we're looking forward to hearing your good ideas if you've got them and you want some help with pursuing those come let us know Thank you very very much for the outstanding talk Thank you


Race, ethnicity, and ancestry are three different concepts that can be used interchangeably in health research. There is no consensus on the definitions of these terms, leading to inconsistencies in research and a lack of clarity for researchers and readers. This paper examined the differences between these terms, assessed their reliability, and provided guidelines for using them in research. It was concluded that race, ethnicity, and ancestry should be treated separately in research, and that self-reporting should be preferred over observer-assigned classifications. This article was authored by Clara Lu, Rabiya Ahmed, Amel Lamry, and others.


Hi everyone, Joe for jaspyscasebrakes.com coming at you with 2020 Gold Rush shoe box collection, multi-sport edition, one box, random hit break number three from jaspyscasebrakes.com. Pretty easy stuff. See the box right above my head? I'm gonna open up the box. We're gonna type in the hits, randomize your names, randomize the hits, and see what you end up with. Could be some amazing stuff in here, ladies and gentlemen. Big thanks to these folks here for getting into the action. Anyone here watching? I think James is around. I saw him earlier. Maybe Jack B will be around. Maybe Nick Stober, I thought I saw him earlier. Anyway, good luck whether you're watching live or whether you're watching the replay. Cross your fingers, good luck. So let's change the screens right there. Let's open this up over here. See, I don't want to reveal too much, but that's kind of what we have going on in here. The cards first, we're gonna get, I'm at a Walter Payton calling card autograph. Nice. Walter Payton calling card autograph. PSA DNA authentic autograph. All right, next one is, ooh, a Don Mattingling transcendent autograph. Purple, nine, five, and 10. That is awesome. Transcendent autograph, nice gold frame on that one. That's out of 10. It's Jose Ramirez, and Francis Gollandor. Dual material signatures. Yeah, I think I can pop this open without breaking any kind of sticker seal or anything like that. Nice. Two color quad relic dual auto. All right, so that was Jose Ramirez, Francis Gollandor dual relic dual auto book from NT baseball. And we've got, oh, nice, a Roberto Almar Cleyt card from Flawless. That's really sweet. The old Nike logo right there on the Cleyt as well. You can kind of see it. Nice, yeah, you haven't broken Flawless with us yet, Dan. This stuff is awesome. Cleyt, Cleyt spike, there you go. Nice, however you spell that. More card. Yeah, we've got an old hockey player, Denise DeGiordi, gold tender. Oh, I should probably show you on this screen right here, there he is. Denise DeGiordi, 1994 Parkhurst Tallboys. Autograph authenticated by PSA DNA. Denise DeGiordi, Tallboy, DeGiordi, Tallboy Autograph. Any other cards? One more card here. We have John Stockton, Flawless. Nine out of 10. Nice little number on that one as well. To the jersey right here, this is right here. We've got, is that Frank Thomas? There you go, that's Frank Thomas, right? I don't know of any other Thomas's and White Sox colors. It's number 35, I think. Yep, Thomas is number 35, there he is. Frank Thomas Autograph, number inscription right there. Beckett sticker, Beckett card, also all included. And is this a replica jersey or an authentic jersey? No, it looks like no tags on the back here, so just a replica jersey, so it probably won't have all the logos there. Now, it looks like it has Chicago printed on the front though, which is pretty cool. And another number on there, so it's kind of hard to see, but pretty nice, all right? Yeah, usually replica jerseys, right? So Frank Thomas, auto jersey. So that's one, two, three, four, five, six, seven. Should be two more in here. We've got a hockey puck in here, National Hockey League official game puck. Wow, sorry, Bobby Hull and Brett Hull. That's pretty awesome. So that's eight, here's nine and 10. We've got an Angel helmet here. That looks like Joe Adele's autograph. Oh yeah, they're Joe Adele. Sometimes they don't all have the stickers right there. Nice, you can see the JSA card inside. The JSA sticker must be there somewhere. The fun little mini-helmet. Joe Adele autograph mini-helmet. Last one is a photo. Oh, we know this guy. In his Penn State gear, Saquon Barkley. There's the JSA right here. And there's his auto right there, SB, Saquon Barkley. Nice, yeah, King deal. All thanks to Mike Rousseau of all people. Saquon Barkley, autoed eight by 10. That's one, two, three, four, five, six, seven, eight, nine, and 10 items. You can see empty box right here as well. Slow, a lot of great stuff here. So let's, yeah, let's roll it. Let's round, that's all I gotta do now. Let's roll it. Let's randomize names and hits. Snake eyes, right here. One and two. So Chris Miller down to Justin. Maybe King deal could be. Well, Chris Miller down to Justin. Let's get those lined up in here. And then two times for the hits. Good luck. A lot of great hits here. One and two. We got Denise DeGiordi, tall boy autograph down to the Roberto Alomar spike. Dan was asking if those spikes are common in that flawless baseball. No, they're not. They are cool when we've hit a few of those though. They are cool when they get hit. All right. Chris with the tall boy autograph. Rick with the dual autograph, dual relic book. Corey with the John Stockton flawless autograph. Brian with the Saquon Barkley autograph, eight by 10. Corey with the Joe Adele auto mini helmet with future star for the angels. Rolando Lewis, nice Bobby and Brett Hull dual autograph, Chuck. Jack B with the Walter Payton calling card autograph. James, this is what I think James wanted. There you go, nice. James got the Don Mattingly transcendent autograph to 10, I think. Nick Stober, the Frank Thomas autographed jersey. That's pretty cool, the big hurt. Trust me, she'll like it too. And Justin with the Roberto Alomar flawless spike. Right there, let's take a quick look at everything. Thanks everybody for getting in. We've got another one of these in the store right now if you want to get into it. And we can make time for this. These are very quick breaks. We can make time for this tonight. So we're slowly running out of time. There's the Joe Adele right here. The puck, nice official game puck as well. That's pretty cool. The spike, the dual relic, dual auto book. There's your graded Don Mattingly right here, nine, 10, graded in nine, five, 10. The Walter Payton, the John Stockton and the goalkeeper right here, the goaltender. There you go. And there you have it, ladies and gentlemen. I'm Joe for jatsbeescasebreaks.com. That was 2020 Gold Rush Shoebox Multisport Random Hit Break number three. Another one in the store. We can knock that out tonight. Make it happen, jatsbeescasebreaks.com. Bye-bye.


So hi everyone. Can you hear me there? Mic test. Good. Yeah, so we are going to give some of our colleagues a few minutes so that they can join. So maybe we start at one or five. Okay. Mic check. Will Fred, can you hear me? Mic check. Good afternoon. Hello Grant. Say something. Can you hear me? Yeah. Mic test again. Okay. I think we can start. Hi everyone. Welcome to this data use session. Discussing a little bit or sharing experience and practice from the field. On the use of data. In routine information. So this session we are going to be a couple of presenters. I and Elaine will be chairing this particular session, but we have filled experience from Togo coffee will be kind of presenting. We also have a story from Tanzania. Clement Kinga will be presenting. And also Haywood will be presenting his story from Chinzali, Zambia, and of course, Eric will be also presenting his story from the use of data use packages. One of the key thing about this particular session is that last year. In the DHSU annual conference, the theme of the DHSU annual conference was data use. And it was more or less focusing on how to turn DHS to information interaction. Now this particular year we actually kind of taking a stock and see what has happened within the year. And if we have learning experiences from pushing DHS to into actionable decisions. Maybe a mic to you to speak a little bit before. Well, for now you've said it said it very eloquently there. And as you said last year we looked at the kind of absence of data use stories that have been documented. So this year we're really interested in in hearing from the experience over the year around data use. So I won't say much. So we can hand it over to the first presenter. Hello, can you hear me? Okay. Let me quickly tell you some two stories from the experience we have in Togo regarding data use. The first one is about district and the second one about region monitoring. This is a photo that we took some some month ago. Some of you may have recognized the guy back in the, the photo. Can anyone guess? Karin Prosper. Yeah, who said that? Yeah, it was Adam actually. I went into the field and to observe a district monitoring monthly monitoring meeting and I'm not on the field on the photo because I was the one taking the photos. So it was very interesting. They were all together of a 20 help facility managers all around the district management officers looking at data. Data was examined being examined in two ways. The first one is data quality. How qualitative was the data. So they will run this WHO based data review into the DHS to and they will identify missing data inconsistent data and they will discuss with the community managers to understand the challenges and address them. And secondly, they are looking at performance. How performance the district is and which ones of the help facilities are dragging the district back or which one are pushing the district forward. They will use this kind of data to of table to it is actually in the DHS to what you see is the Alma card. I don't know how many of you are familiar with the Alma card Alma is the African leaders alliance against malaria. So they, they, they, they put malaria in a high level engagement from university level and primary level level. So they set a series of indicators they have to be monitoring every quarter and they have to report on it to be accountable on it. So we took that Alma card and we actually customize this into the DHS to building it directly into DHS to as the facilities are reporting the, their, their performance. It is being built directly into the DHS to so that the district can look at its performance, the region and the whole country. So this card was, was very interesting because they were discussing it. And one thing that we appreciated there was the data availability data was available to inform this card because it was something very critical at the highest level. And one of those health facility managers tell actually told us a story. He said three years back he was appointed as a facility manager. It was in 2017. He went there and there was no data. He had to reconstitute all the data from the latest or the registries that he can found there. But three years after in 2020, he got appointed to another health facility. Then because we rolled out DHS to in 2018, he was able to find the data all the way down. And that helped him a lot in doing what in doing two things. First of all, doing the review of the performance of the facility for that year. And second one, built the facilities micro plan for the next year. So data was available. The second thing that we noticed was the denominator challenge. We noticed that some facilities were above 100% where such facilities were constantly below 50%. And the explanation was that some populations are very moving. And some of those facilities were actually at the border between Togo and Ghana. So people will be coming from Ghana to attend the facility. And that can sometimes skyrocket the performance. But we discussing with them, we have identified that it is very easy to have the denominators at the high level, at the country, district level, but it's more delicate to have it at the facility level. That's why denominator distribution has become a subject of concern for us. And we are doing research on it. The third thing is that almost no analysis were done at the facility level. And we are just populating the data and DHS to and then waiting by the end of the year to discover how performant they have been. But at the district level, the analysis capacities were limited. Most of the time it is the HMIS team that was in charge for analysis of the data. The program offices were not so familiar with it. So what we decided is to provide them with a simple guide for data analysis at the district level and then at the facility level. That was the experience from the district level. That is the second story from the region level. What you're seeing in red is one of the six health districts in Togo. It is called the plateau region. The plateau region, as you can see on the map, is the largest. And it also includes the largest number of facilities of district 12 facilities actually. So when a friend of mine, medical doctor, colleague of mine was appointed last year as health region manager, he wanted to have an overview of the performance of his region. And he discovered that the region was actually a bad performer in health programs. So he wanted to have a clear overview of the programs and of the districts. So he asked his region managers to provide him with data. That was the nice excel sheet he was provided with. And the funny thing is that it was pulled, the data was pulled out of DHS2 and then pushed into excel to show him actually the situation. He was so dissapointed that he sent that to us saying that you guys have been working on DHS2 over years, but that's what I'm getting. So what can we do? So we convened with him a meeting where we provide him with what we can actually be able to design a DHS2 as a dashboard. He was so amazed that he said, I want to have this now. So actually at the moment we're speaking, they are in a workshop to actually configure those dashboards for him so that he can be able to be seeing the performance not only of his programs but also for the district because we told him that he can be seeing the health district. I was saying that they have 12 health districts with a color code that enables him to see which one is in green and which one is in red. So what are we planning to do moving forward? The first thing is that we have six regions in the country. The plan is that if once the experience is successful in one region, we can scale it up by the other regions. The second thing is that we have started discussing with the minister himself so that he can have these dashboards directly in his office so that he can be able to be discussing with the regions. The improvement we plan regarding the system itself is about SMS alert. Someone was talking about it in the previous sessions. Actually he has to go to the DHS to see what is going on. But if we can configure SMS that can alert him once a district is below or above a threshold, then he can go now to the DHS more frequently. And we have targeted, we have triggered a positive divine research, which is about what? When we will be looking at those districts and those regions, we will be identifying those that are well-performing and learning from their performance, we can replicate them to the other districts without putting not so much money. So those are the stories from Togo and I thank you for your attention. Thanks, Kofi, for this wonderful experience. Like the way you kind of ended up with talking about getting information out of the DHS to customize message for these decision-makers, managers, so that they can make some action out of that. Our presenter is Clement Kehinga from Hispansania. He will join us online. Is he there? Clement, can you hear us? Technology. Clement Kehinga, if you can unmute yourself? Yes. Can you hear me? Yes. Okay, thank you. You can take it over. I will be changing the slides for you here. Hello, my name is Kehinga. I'm presenting the development and the use of national alumnus H and H, square card in Tasmania. Next slide. And this photo is launched the day when we launched the square card. It was launched next slide. Can you see the slides? Yes, I can see. It is the historic background of the square card is that between 2009 and 2015 we have the national roadmap of the strategic plan to improve reproductive and maternal newborn and child health and adolescent health, which called for periodic tracking of performance of interventions. But at that time we did not, we only have DHS-2 data, which one helps to analyze and develop Excel templates. And the knowledge of using that technology was not very universal. So the ministry in the section needed some sort of tool for tracking and for accountability. And that's why we allowed the decision to develop the reproductive maternal newborn and child health square card based on the arm malaria square card. Next slide. So I will give you a short background of our square card. Toward the end of the implementation of our national strategy for maternal health, child health and adolescent health development, we developed a short-term plan which we called the shape and plan for the years 2014 to 2015. And we decided that it was the time also to include the problem of the arm malaria square card. So we started to work on that. And the good part of it, the new health sector strategy also called for the square card to be included in our plan to be used nationally, regionally, and also the local governments and the councils. So it was a high policy decision that gave us the big push to develop that square card. Next slide. So in 2014, that's with the support from the U.S. and the other partners. We developed the first square card and we used the normal color quality of green for target achieved on track, year of progress but not efforts and ready not on track and the grade for that are not available. And it was launched by the president of Tanzania, he's excellent. So this square card was launched together with the shape and the one plan so that during the first two years, that document, the square card should go hand in hand. And it includes indicators for tracking key maternal and the child health indicators to identify botanical drugs and it would have action for national and regional and the local government decisions. So in collaboration with the U.S. and the other partners, the MOH has been continuing strengthening this square card as a management accountability tool. And now from 2015, it's seven years of operations next. Let me now share with you the implementation levels and updates. Our square card is implemented at the national, regional and district level. I heard from my previous presenter that it goes to the facilities. For us, the facilities, because of the problem of the nominator, like what has been said about Togo, we said that our calculations will start at the district, regional and national for his facilities, the justice, correct the aggregated data. The square card does address priority indicators with variable data that was agreed by state stakeholders. The first square card was for January to March 2014. And the information comes from the most of the information comes from HIMS, the HSO, but there are three indicators come from other systems. The one indicate on national insurance and the other indicate on vaccination. They come from other systems, but most of the data comes from THS or HIMS. And all the accounts, we have currently we have 184 of them. They are responsible for data collection, quality auditing and electronic capture of the data. Next. We will show you the key success factors. One is the use of the square card as a management through ATO levels. It means from more district regions in the central level and to some extent the facility level. Number two, the decentralization of the square card and the use at the lower level from the national to include the regions and the law government. Third, the integration into management processes and the use at the critical level, high level. And fourth, wide dissemination and public sharing and another success factor is the evaluation and documentation of the practice. Let us start with the first. Next. So on the use of the management through ATO levels. It is used by the government in both national, regional, district level and law government. We have already updated the square card every quarter time remaner. Usually 30 days after data has been entered into the system. That is one we can export the data into the square card. Number two, all the indicators that are extracted from the HIMS so are fully populated. There are two components. The first component is the safety data which comes from the HIMS and the second component is the denominator which comes from the Bureau of statistics the population data. Indicators are reviewed based on the latest strategic plans like now we have new strategic plans also the square cards were designed in 2015 but now we have two different new strategic plans but the square card is still responding and the wide range of stakeholders at both levels are using the square card and therefore logging the authorities to use the square card. As a function of the square card they are also using the action tracker. Our square card is the action tracker that can be documented and used for decision making next. The second one is the centralization of the square card and the user to region on the ROGA levels. The square card is being used at the region on the ROGA levels by the government local partners. In the initial slide, in the previous slide it is the user to the high level. Now this is the user to the local level. When a NGO is working in the region or the district they use the specific square card for that district. Secondly, they use the regions user square card to support the prioritized resources, to program planning and also to discuss the nature accountability of the accountability within the ROGA. The most part from all levels, they use the square card to more need to progress and support implementations and the regions ROGA have improved the safety delivery based on the square card. In fact, they are using it for, if they start from the square card they are being used for for for budgeting, they are being used for expansion of services and also to collect if there are any shortfalls next. Then the third one is the integration into existing management processes and they use it in political level. You see in the technical working groups, also there are a number of routine meetings and other things. So now the square card, using those meetings, the square card is reviewed nationally, regionally in the ROGA in the existing management meetings including technical working groups. The actions are captured in meetings and in the action tracker and the implementation is also documented at your levels. And the square card, they also use the first provision of performance management. In fact, the indicators that are in the square card somewhere from the from the integrated management tools. The square card is also used for planning, budgeting. Our budgeting cycle learns from July to June. So they use this data to form the square card. They use it for budgeting. Next slide. Kihinga, you have one minute remaining. Yes. Okay, thank you. Let us skip this one. Let us go to the conclusion. The next. Yes, this is why they do it succeed. The involvement of the president himself of the president who have made the square card one of the agenda during their visit to the region district and number two is the high profile of the ranch of the square card. All the high officials were there. They started with the high awareness in the country about the need to improve the health of the mothers and children next. The other factor is the simple color code. The next factor that for our success is the discussion of the square card at your levels district and the regions. And also the regular HMI is just two data at your levels. And also the country technical skills from the MOH and the other partners next. So based on the success of our square card, there have been a number of other implementers also coming with the square card because the success of the square card has been influenced and they also want to emulate on their success. For example, we have the square card now, we have the nutrition square card, we have the basket funding square card with the environmental health square card, but the RMSH was the first. So these are all products of data based on that success. Next slide please. I thank you for your attention and that's the story of our square card in Tanzania. Thank you very much. Thank you for that interesting presentation linking up the square card with the political awareness on the country. Now it's up to Artur with Shinsali story. While Artur is setting up there, there's a question coming in on the chat. Can you hear me? There's a question on the chat from Yvonne that Clement or Joseph if you could respond within the chat if you don't get time to it at the end. Thank you. Where are we? We're going to switch countries and go to Shinsali in Zambia. If you can see which side is it? Shinsali is a really remote district in northern Zambia 12 hours away from the capital and it's really in the middle of nowhere. It's been implementing DHS since 2006 DHS 2 since 2014 and like every other rural district in Zambia it enters data at district level. There was a Gavi project that focused on data entry at facility level that started exactly the time that COVID came in. I was in there drawing up the implementation plan when COVID struck and fortunately Gavi said carry on, let's do it anyway. I came back a year later after the project had been implemented and I used I spent a month there doing participatory research talking to all the people involved about 50 people in the district went out and visited the six high turnover districts and using a data collection tool that was standardized. In reality what happened was the first six months of the project was spent converting ordinary face-to-face learning materials into distance learning and we worked very closely with South Africa to implement distance learning but it took six months so the actual project itself was six months total of which the first six weeks was teaching people how to enter the data and it was entering data is not very difficult if you can use a WhatsApp message you know how to enter data into DHS too. That was not the big deal what was interesting was that people then started to own their data, they tried to in the attempt to understand their data and they attempted to use the data and I think that quote on the right-hand side says it all we used to just send the data to the district now it's ours and we own it and we try to make it better the other major thing that happened was the district information officer was really insulted when I said you just glorified data entry clock after the facility started to enter the data she suddenly realized that all she had been doing for the last five years was entering data and she was suddenly liberated to actually do some work in data quality control and data use and I think that was one of the most important things about this project was entering data into the facility liberates the district information officer to do other more useful things the other thing that happened was that the district health management team suddenly had a focus for their activities they were suddenly the immunization officer was looking at his EPI data the mother and child health program officer suddenly could see that people were coming to immunization I mean for antinatal care all of them were coming into town and there was no antinatal care being done in the periphery and she started to realize the functioning of the program based on data the other thing that was really surprising was and I had quite good entry into the ministry of health the M&E office I mean M&E director was an old friend of mine and they suddenly realized who there's a whole lot more that we can do and they started looking at data use guidelines they started saying oh that's what we need to do and they put a lot of effort into developing data guidelines we managed to convince them that data use should be introduced in the pre-service facility they had been developing pre-service guidelines but they didn't contain data use and we started talking to them about what we've been doing in Chinsali oh yeah we put that into the curriculum good idea Arthur it was really really fascinating they also started looking at monitoring evaluation frameworks yeah and then the normal ministry of health blah blah about feedback mechanisms and community health information systems that nothing has ever happened but there was discussions about data at every level but there were major problems it wasn't all rosy and we used I don't know if anybody knows the prison framework but we used the prison framework to look at the organizational, technical and human factors and by far the biggest challenge was the organizational side of things this people had the data in front of them but they didn't have any idea what to do with it there's no point having data if you're not told what you're expected to do with it so at each facility was doing completely different things with their data and there was no standardization no ability to compare districts or facilities that's where we should we'll use in future the scorecard that's a really nice concept the other thing is demand for data unless there's an institutional demand for data nobody's going to use it if it's not in your job description if it's not part of your monthly activities then people are not going to use data and that has to come from all levels but especially from the higher level for planning monitoring and supervision the third big organizational problem was that the data all traditionally just went upwards and nothing came back again and people get very discouraged when they don't get feedback and there's actually no system in Zambia to send nobody uses DHS to feedback features to provide feedback to the facility level collectors the population has been mentioned everywhere and we're going to talk about it later this afternoon but that's another major issue technical DHS2 those of you who worked with Zambia DHS2 and I've seen Nora shaking her head it's a mess but it kind of muddles along and is functional needs major revision but people are used to it and they know how to do the real problem is that the parallel systems don't feed into DHS2 so we have no logistics data there's an EPI program we were supposed to implement the EPI app but we didn't only 40 of the 100 data elements no sorry not 40% of the data elements required for the EPI app are actually available so 60% no vaccine availability data no cold chain data no human resource data so the EPI app is I don't know whether anybody is able to use that app but certainly I haven't ever seen it properly used and that was supposed to be core to it human side yeah I mean there's an amazing amount of skill at health facility level to use computers I mean most of the people at facility level actually had their own computer many of them were using their own computers for health facility work but that had never been tapped into and it is still not tapped into and there's a huge potential at facility level for computer skills the people at facility level they also they're not exposed they had never been a single training anywhere in Chinsali people at facility level on information systems they're just not exposed and as a result there's very little discussion data use work practices had actually changed that was what I went to go and look at data use work practices had changed considerably with the entry of data timing timeliness and completeness of reporting and I think to me the biggest this is my lesson not for is that distance learning really works at facility level even a rushed hastily cobbled together unprofessional distance learning which is what we had worked incredibly well to get people motivated and the key to the distance learning working was to train local district health management team members to be the trainers so we had four DHMT members who then became trainers and they then became the biggest advocates of DHS and with the district working towards data use then the entire the district team working towards data use the entire district started working the data review meetings that Coffey was talking about they held them and they were absolute waste of time before but now the health workers we gave the data review meetings some structure they looked forward to this and it wasn't about finding faults with districts it was really focusing on performance because all the data quality stuff had been done before and you focused on performance at the data review meetings rather than problems yeah so again we won't talk about populations we they will talk about that later but there was a field of blooming flowers in terms of data use unfortunately the project stopped money was withdrawn technical support didn't come and the whole thing collapsed the people are still there with their skills they're still going to their data review meetings they're still entering their data 100% completeness and timeliness but the whole motivation the whole drive has kind of gone away the ministry doesn't have the money to follow it up the ministry was really excited by it but they're unable to follow it through and it's stuck a little bit of water what have I done okay you can see it anyway a little bit of water and those flowers would come back to life it's not going to happen overnight it will happen how much time are you good zero okay that's fine that's all I need we need guidelines on data use we need ongoing distance education for example half of the staff has moved so we need to train the new people coming in that process is now stopped the district health management team is all excited to have the power to change things and there's no ability to bring in new processes and new systems and there's very little that we can do about setting using data in planning monitoring and evaluation but the potential is there we've planted the seed it just needs to be watered and the water time is a little bit short so we'll just go ahead and jump to our next presenter Eric can you hear us there joining us hi Wilfred yes I can hear you can you hear me yes take it away thank you can you allow me to share my screen please oh thank you Wilfred can I share my slide I don't know whether this is the one that is shared I think it should be able to share your screen okay just refresh and then yeah I think it should be the same please share oh so we share can you see my screen hello Wilfred yes we can we can see your screen okay thank you very much for taking time to listen in and also share in these data use experiences and practices my name is Eric me I'm Babazi and I will share with you some of the experiences we have seen in Uganda and also in other countries that we have worked with and also supported the concept of data use really would make a lot of sense starting to look at the data sources because wherever we have been in most countries the sources are partly to partly contribute to how we ultimately use the data in country so health data largely is captured at health facility or within the community and depending on the point of contact today we are talking about non health areas and so we may have to thinking about how to work with the sources where this data comes from the tools that we use are largely standardized and aggregate at different levels and also to note that data national level are also accessed through both electronic and manual system so for data use packages wherever we have to support them it's important to take note of some of these levels of access and where the data is ultimately coming from and of course at the national level DHIS2 has played a very key role in providing electronic records for use I thought I would also speak a little bit on other sources of data because again these contribute a lot on how we use the data in country where I come from we have data from administrative levels from inventory supervision management meetings where for example in Uganda they are able to track the number of times national level teams are able to do support supervision at lower levels so it's important to take note of some of these and also the population best health surveys that deal with district health surveys and national health surveys we have data from institutions and academic data as well and then health information research that do clinical trials and longitudinal community studies so in the health domain the sources are really quite broad and pulling all these sources together to make sense is really quite key important. We are having currently a discussion on how to pull data on civil registration and vital statistics to be able to contribute to some of the program data that we are looking at at the national level I'm sorry to interrupt you there Eric there's a lot of background noise so I would just ask people to make sure that they're muted. Thank you Thank you Nora. Also we have data on Sentinel events as well as civil registration and vital statistics so in terms of packages really that we have been dealing with a lot largely it's data on data first of all generated through the DHIS as the main repository and then also data on using generic applications like scorecard bottleneck analysis and also the data quality apps yeah so we we've looked at large delay and by and large the analysis and visualization features from DHIS and these are for all teams that are using DHIS too and of course the additional applications like scorecard bottleneck analysis the data quality applications one that used to be called the WHO data quality application and so these play a very key role in terms of how to use the data that is being generated and so how the applications are presented becomes very very important in some of the screenshots you see for example these are screenshots that were taken from one of the facility offices where they are able to generate these visualizations and then pin them on the dashboard on the notes board but of course this does not really quite often demonstrate the use of data pinning the the charts doesn't really help that so we started pushing to see more and more of how this data can be used beyond looking at a dashboard beyond looking at a notes board beyond looking at a scorecard showing performance trends using some of these tools so in terms of experiences on how this has been used by and large DHIS2 plays a very key and significant role in the provision of data and for our case it's compilation of the annual health sector performance report which is really a key report that is important for the country but also data is comprised in that report is generated from some of these features secondly we have been working with a program that deals with section reproductive health as well as gender based violence that generates data using scorecards important to note that data generated from DHIS2 using the scorecards has facilitated prioritization of indicators generating targets and also priority data sets for analysis this particular area we worked with a couple of members of the Ministry of Health and to generate something called an indicator handbook and that handbook summarizes key indicators that are used in monitoring the project and the interventions then linkages and integration of key areas these we have gone ahead to link for example HR data generated from the address with the DHIS2 to be able to address issues of denominators I had I think Henry talk about this earlier on we've also the packages have the awareness and SPA planning we have the bottleneck analysis currently in around 35 districts that are using it to do research to do district planning and the data that is really generated from the bottleneck analysis which we worked on recently facilitated planning for this cycle of using the bottleneck analysis we have seen also this in other countries in Tanzania I think also in Rwanda they are trying to use the bottleneck and the scorecard to do the same there is a video on this that we have posted in the chat the participants can watch it in the free time then linkages within the community initiatives we have a story of district that where politicians used data generated in the DHIS2 chats to to create a boa hole to identify places where they had the number of problems and then create boa holes there and further experiences on data used as seen in the DHIS have spread the facilities conducting weekly CMEs what we call Continuous Education in Facilities and these ones that are done based on some of the analysis that is generated from the apps and the systems we have district quarterly and monthly data review meetings in some of those screenshots based on the chats I need to also mention that the data use in a big way is contributing to innovations for example we did generate work with the community to develop the smart display app which was to further show and simplify the way this data is analyzed and visualized in different places currently in the ministry on the ministries to monitor screens we have deployed that in the city hall in the main CBD and so on then also to mention that routine audits have been conducted based on the data that is generated from these chats routine orientations on data reviews I mentioned that and then basic infrastructure support on internet and devices which is really by and large generated based on the reporting rate completeness for example within the HIS too that helps us to understand which facilities are not reporting why are they not reporting and so on so these country experiences have quite been enhanced by the use of data and the HIS too and the application packages that fall within them there are a couple of focus areas which we think are very key for data use in most of the countries that we have worked with and this is investment in analysis and interpretation this is very key there is no way they can use it and we are also understanding with time that just generally having dashboard, spinning them on walls doesn't really help much then additionally we are seeing data engaging and engaging middle-level managers one for them to generate demand so that data is generated based on demand and then two training and capacity building for these middle-level managers and then the other key component is dissemination of data use products earlier I mentioned about the indicator handbook which is a very short summarized manual for indicators here we also talk about bulletins this could be either monthly or quarterly or even weekly bulletins performance so that action is able to be taken we talked about league tables that need to be also generated and distributed then the last part is the tracking of actions and this is a bit new we have not really used this this application this called action tracker that we need to have a bit more increased investment and roll out of applications such as BNA and action trackers so that if you are able to monitor the investment on some of these data use packages and applications then some of the drawbacks we have observed one of course large datasets is one of the key for example for the case of Uganda then operational level not involved in the design work overload for facilities we have clinicians turning into data collection and that becomes a bit of a challenge in complete and inconsistent data then missing key data points I mentioned earlier point on linking with different with different sectors and then parallelism where we have you know different programs running different systems as well as start turnover I think I made a timer and I want to stop here thank you very much we started five also we just have one minute remaining to end our session we have heard a lot of themes here institutional data use from we have heard a lot about this core card to promote data use at the national level sub national level and etc but I've not really heard a lot about this data use at the facility level and I think that's where the data source is coming from maybe I could pick a brain of Nora because somebody mentioned Nora if you can speak something about that anything but for one minute Eric pointed out that one of the big problems is the large data sets and I think that if we can start to tackle those and try and get them reduced I think we may sort of start to have a way forward because if you talk about data use at facility and you've got data sets that look like this where on earth do you start what do you define as important what do you define as what you must concentrate on and what do you define as you must have good data quality on so we seriously need to reduce our data sets and we have historical reasons of why we collect these massive lists of mobility and mortality and age and gender groups and things like that and we need to start tackling those and I'm quite sure that if we reduce that the facility people can look at can understand and move forward thank you our time is up if you have any comments, questions on data use we are on the COP there's a data use channel there you can post there some questions and comments and we can continue discussion there thank you very much for your attendance and let's clap for each other thank you


Ah, what is happening? What is happening, everybody? It's, um, fuck, what day is it Wednesday? We're down in Adelaide. Not a bad day. It's pretty cold, actually. I'm just staying at a friend's place while I'm down here. So, this morning, I went and got a coffee. Checked out the Anytime Fitness, which is around here, which is about five minutes down the road, which is all good. So, um, I'm going to hit a push session. Chest, shoulders and triceps. I'm not, honestly, guys, like my attitude is not the same as it was last time I went away. I'm not cutting. You know, all I'm going to want to do is probably train four times a week and keep the eating up, and that's all I can do. So, just making sure my sessions are well-fuelled before and after, pushing as heavy away as I can, and hopefully I'll be back in Alice Springs in three weeks at around about 100 kilo. And we'll see how it looks. So, not much to say, really. Just feeling a little bit, I don't know, tired this morning, I guess.  So, as you can imagine, I got a little bit tired. So, I slept for about 10 hours last night, but I definitely needed it. And I thought I'd show you guys my little mate here. The person I'm staying with is actually raising this little bird who doesn't have a wing. Where is it? There he is.  Okay, you can go down now. So, anyways, guys, I'm going to get a monster on the way.  That's something I'm committed to trying to sort out whilst I'm on holiday is actually controlling my caffeine intake. As well as that, also controlling something else, but we'll get into that at a later date. That said, guys, today is day 7.57, 56, 56, day 59, 60, day 60. It is day number 60. Leg up. I've got the biggest names on the poster, and I think for good reason. Yeah, that song, I may be... Did it miss California? No, it's a good song. Well, you're going to get to enjoy these songs performed live in Adelaide. You are going to R&B Friday's live. Oh, my God, thank you. Honestly, you asked me why I like living in Adela Springs. The first time I go to try and go to the gym, I get a pre-workout drink. I go to the gym.   I've been trying to get a motherfucking park for 20 minutes, God damn it.  You don't even try to get a park in Adela Springs. They're just there. It's fantastic. Anyways, shoes on. Monster getting drunk as we speak. I've got a water bottle. I've got my headphones. We're going to go smash a push session. I might get some footage. I doubt it, but it should be good going in a brand new gym. That's always fun. So let's do it. All right, guys. Anytime fitness goer bathroom. And the chest is indeed pumped. We've had a good session. Two pressing movements. One incline, one flat. Two cable crossover movements. One from slightly above the shoulder and one from below. It's a pretty sweet gym, actually. All right. One chest session in the books. Didn't do shoulders and triceps because I've actually got that organized for tomorrow with my man Dylan, the guy who I was meant to compete with, but never did. So he lives down here in Adelaide, so I'll text him. And luckily he told me that everything else is spent except for his chest. No, except for his shoulders and triceps. So I stopped after chest. It was a pretty good workout.  It's right. I'll show you. It's the top level of a building, the entire top level. So it's got windows all around the outside.  So two pushing exercises. I started off on my all-time favorite, which I haven't used for ages because I wasn't a member, which is the Hammer Strength Incline Press.  Following that, we did two fly movements. One on the pec deck and one on the cables. And yeah, chest is great. So chest is pumped. It's all good.  I'm going to buy a whole cooked chicken as well as some carb sauces from the bakery.  Last night we went out for Cafe Primo, which is pretty nice.  But for me, last night it was great. And I've got to get a haircut too. But yeah, as I said, first of all, we're going to the supermarket and get some food. And you know what, just before I do go, I am going to call it here, guys. You know what I'm doing tonight. I just told you, tomorrow's vlog is going to be sweet because I'm going to go to Anytime Fitness Miley and catch up with Dylan. Probably have a meal afterwards. You're going to see who the season, what is it? Season B, INBA, Men's Physique, tall class winner was for 2016. That's who I'm meeting up with tomorrow. It should be an awesome session.  But I probably won't be. So it should be a good day. And yeah, one thing I have been struggling with, guys, is just motivation for the gym, man. Motivation for the gym. This is the point that I can never get through. I just put up a video yesterday. It was called to minicut or not.  It's just going to be bad for me.  You know, when I'm feeling lean, it's easy to eat a lot. And it's easy to... You know what?  I don't feel like eating. I really don't.  You can do it. You can do it.  And then I'll start cheating on my diet. I won't be doing this aggressive minicut because the only reason I'd actually do a proper minicut is if I was going to be extremely aggressive with it and get it done like that, in and out of a caloric deficit for three to four weeks and be losing, you know, at least a kg of body fat each week for those four weeks.  But it's going to compromise the gains that I've made in the last 10 weeks.  I think if I can get to four months, 16 weeks, I think I'll be over that. If I can get to 16 weeks with some relatively, you know, alright shape in the right lighting, I'll be happy and I think I'll be at 100 kgs, which would be another nice milestone.  If I could see on the scales legitimately, 100 kg in the morning and be in alright shape. Honestly, I'd be so happy with that.  It'd be nice to say, I know numbers mean nothing, but seriously, that would be really nice to be able to say that. So that is a goal and if I minicut now, I'm never going to get there. So with that said, guys, that's how we're feeling tonight. On the 60th day of games, I'll hit you with the side chest and we're out. That's Kevin Laveroni, by the way. He's the man. Here he comes.