Hello, I hope no one's offended by VIN that I love it, and there's a VIN thing tomorrow at half eleven if you want to come along and talk about VIN because it's awesome. So I'm going to quickly talk about dependency injection in Ruby, which apparently is quite a controversial thing as I've found out today. To understand why I'm talking about this, I'll give you a wee quick bit of background about myself. I used to be a .NET developer before I saw the light and became a Ruby developer. One of the things I loved about being a .NET developer was alt.net, and there's the sort of thing that brought testing and all the good stuff that we take for advantage as Ruby developers. One of those things that I loved the most was dependency injection, and I did a lot of talks on dependency injection, loved it a lot. In fact, the first question I asked on Stack Overflow when I became a Ruby developer was, how did you do dependency injection in Ruby? I was told, you don't. It's true, you don't normally. In .NET we do dependency injection to make things testable, but everything in Ruby is testable. It's easy to test. But there's another thing you can do with dependency injection, which is a really cool thing. You can do it in Ruby, but dependency injection to me is a pattern to use. I want to go for a quick wee sort of monologue about how I got to where I am with this dependency injection stuff. It starts off when I came out as a first Ruby developer. I saw a lot of code like this. If you imagine these are Rails controllers, I couldn't be asking a full Rails app together for this, sorry. I got in here where we do some finder method, and imagine this here is an active record finder method as well. It would return me a class and you call something on it and you turn it. Is everyone seeing code like that? That's not unusual. I could run that and you'd see it working, but who cares? I didn't like that because it has a database call in my controller. I really, really don't like database calls in my controller. I know in Ruby, tentatively, it's kind of all right, but I kind of don't like it. I move things from being database calls to sort of class level methods. I'm not supposed to call them that anymore, but for the purpose of today, I will. I had a lot of self methods, a lot of class methods that would do something. The database call would be in there, it would do some work, and then return back the information that I wanted. I'd end up with something, blah, blah, blah, blah, where's the controller gone? Is it at the top? At the top, yeah. I'd end up with things like this, and then I'd do whatever I need to do to output that to the screen. I had the controller basically doing what the controller was supposed to do very little, calling something, getting some stuff back, and throwing it on the page. One of the things I came to talking with Pete, who's around somewhere over there, Pete, was the thing about what if we want to change that implementation? What if we want to use something different, or in different situations, want to use something else? In Rails, just now, what we'll do is go through and change every single implementation of that, and then take ages and we'd run our tests, and they may or may not break, and update them on it would be a pain in the bum, basically. So after a bit of talking, we went, wouldn't it be great if we had a sort of dependency injection back in Ruby on Rails? So I went away and, yeah, I kind of created it. Much to his annoyance, because he wanted to do it. So at the top here, we've just got a class, some service class. I call them service classes, because that's what I'm used to from .NET. I'm sorry if you don't agree with that. Some class that does something again. And I created this thing at the top here called DependsOn. Now, in this situation, that's very simple. What I've got here is a symbol right next to there, which is exactly the same as the name of the class at the top.  And that's great for that situation. But what if we want something that can change whenever we want it to change based on maybe, based on classic ones, tax calculator? When we want a different tax calculator for a different country? You mean what I call that? Well, I went ahead and put that in. Put some very basic, I say basics, I've only been working on this for like three days before the conference. It's very new. Some very basic sort of factoring support on it. So what I've got here is, as well as just passing a symbol, you can pass a lambda. And that lambda or block or proc or whatever, you get the owner context into it. You can then do something like that. In that case, I'm just returning a different class. So, in this case here, I've got my normal class that I had originally at the top, some awesome class service. You can tell I like the word awesome. It's such a great word. I've got it through here, and originally, if I was to go back and run the one beforehand, it would be a good idea. There. So if I run that, it'll go down here. Them is awesome, just to let you know. When we come down here, just create the controller and put that out. You can see it will run and it will put out whatever I've got on that screen. Now, in the case, in the second case, I've got a wee bit of a switch in there. That takes, that was the original class that you saw. I wanted to now change that. So I've created another awesome class. It's slightly more awesome, because it uses a dirty Harry quote, which is great. And all I've done is changed its implementation here. So in terms of maintainability, this is great for me, because I don't have to then go through and change all those calls and all my code. I can just switch it around really quickly. Or if I want to actually change it totally based on some dependency, something else, I can just change it in here by doing some sort of this statement or whatever I want to do. And then if I run that, it'll say, it'll give me a different implementation. Now, to me, that's what depends injections all about. It's not about testing, which is always how it's sold in languages. It's about this ability to be able to change things in and out really quickly depending on what the context is. So I was kind of starting to develop this, and I kind of wanted to hear other people's ideas about it. That's why I'm talking here right now. Already talked to Pete, we've got ideas, well, he's told me what to do basically. He's put in support to make mocking and stuff really quick and easier, or stubbing, sorry, quicker and easier within RSpec and TestUnit to make that a lot quicker. That's pretty much all I've got to say. If you want to check out the code, which quite little is about ten lines of code, it's very small. GitHub here.  Just tell me I'm wrong. It's great. You get me on there. That's me. I can take a couple of questions apparently. I've got three minutes left so I can take any questions if someone wants to pass me right now. Fine, okay. Quicker to the pub, I like that. I'll shut that down. It seems to be the lightning talks are just in the order that people get to the podium, so if you're really determined to speak, just sort of queue up over here. I'm going to talk about vagrant virtualisation and configuration management very quickly. I'm Gareth. I work at Free Agent. I'll bet everyone knows that. I blog. I curate e-mail newsletter because they're un-vogue at the moment. Here's a number of disparate problems from teams I've seen in the past or worked on that you may or may not be interested in. You may or may not have come across, hopefully you have. Getting new employees started is often difficult. Some developers are bad at what works on my machine. Why is it not working on the server? What works on my machine? Hopefully that's not you. It's a big advantage to running the entire stack of any given software project locally. I spent a lot of time on train and when I started a company that didn't do this, it meant I couldn't work on that train. Pretty specific, but anytime you can't run it, the internet's down. Oh no, it's not going to work. You're not in the office. It's very difficult. Services are a good way of doing various different things. If you can't run that locally, you're running to odd bugs that are difficult to debug again without all the access. Not all developers want to be sysadmins and nearly always end up managing their own local development environment in a somewhat ad hoc and different manner to the person next to them, which leads to odd bugs. Different versions of libc between two people not going to catch you all the time, but if it does, you're going to hit finding out what the problem was. Not all developers make good sysadmins, because that's all stuff. I think there's a number of solutions and they also have come around using local virtualisation. Using some of the configuration management tools like Chef and Puppet, but rather than it all being about the niceties of going like 1,000 servers, this is cool. Focusing inwards and using it for your local development environment and then maybe using it for your development environment to standardise things.  Quick note on virtualisation.  They're probably using it for windows and they're probably using it so they could use IE. All of those things are painful. Throw a hardware at this problem, anyone using a machine that doesn't have maxed out RAM do that first and then things are slow. I say I used to use Vmware Fusion I now use VirtualBox. They got went to Oracle and I'm a bit scared now. There's good tools. VirtualBox runs on Windows, Linux, Mac and there's an open source version so no excuses. vagrant.up.com is the tool I want to talk about for most of this session. It's a long list but it's normally when you're managing VirtualBox there's a GUI and you're clicking things. And there are some config files and there's some properties and some XML things and there's a command line app that you can send very weird messages doing it. It'll set things up. vagrant removes all that and gives you a very simple DSL that I'll show you in a second to show all these bits and pieces. It's for automatic provisioning of those VirtualBox instances using Sheffan Puppet. They're virtual machines. They're often headless virtual machines by default so you're not having to carry around a big GUI. You just SSH into them. You can manage the network stack of one or more VirtualBox machines for doing static IPs if you want to show someone else. You can forward ports from your local machine if that's already on a network. You can very easily share folders in a few ways and you can package these boxes up and give it to your colleagues or put it on a service so new employees can grab it. And I now find myself whenever I go, oh that's a cool project I'd quite like to play around with. I just grab a new environment.  It's like the cloud experimenting with VirtualService. I'm throwing them up and tearing them down and it's liberating rather than having to manage all these things. It's a gem. You're really people, you know what that looks like. At its height it has a vagrant file. Basically a text file called vagrant file like a rake file. And you have a really detail and this is basically the sort of basic. There's a lot of minimal feature would be I want to use a box. A box is simply just a pre-built image with the vagrant tools and an operating system on. And this would be saying I've got a box locally called Lucid32 running Ubuntu and I can run the vagrant tool just say vagrant up against that file and it will spool up a new virtual machine and then allow me to test it into it. You can set up port forwarding. So you might be running a Rails application there but you want access to it from your desktop machine from your laptop. Where is port forward? Send one port to another so you can export lots of ports that are on your local machine so you just go to localhost7000 and it's processing it it's basically forwarding it through to the virtual machine. And there's just a config file and there's one liners and you can add them and take them away. The auto property means that it will automatically discover one that's not in use so I have lots of machines and I bring them up and down and I want SSH access but I probably don't care about the port because there are other tools to manage that SSH config for one and so it will find one that's not in use. Shared folders, again shared folder configuration in virtual box or in VMware is pretty gnarly you have to do a lot of work vagrant gives you a one liner that you can put into these config files. Talking about service based architectures sometimes you want multiple machines you can have a vagrant file and remember this is a text file that you can put in version control and you can share between you that can bring up multiple machines in one file so vagrant will bring up two machines or three machines or ten machines before your machine runs out of RAM. Talking about boxes these encapsulate the tools and the operating system this is a website I put up that is hosting a lot of these boxes and you can find most operating systems WN, Ubuntu Red Hat Gen2 and you can make these boxes internally if you have very specific requirements but what I prefer to do is use config management tools to provision those boxes so this is what doing it in chef looks like again you build up these files and you can say well I've got a load of chef configs and I want this machine to have this role when it comes up you can tie this in with the chef server so if you've already got a chef server setup that you're using for your production stack you can point this at it and say oh it should have the role of this type of machine a developer workstation machine whatever you want and you can do more complicated things so this is one I use all the time to every time I bring up a new virtual machine I want my zshell config and my vim configs on there for two people and this will do that it drags the cookwork down from github and put the config files on there so I get my shell straight away whenever I fire up and throw away these machines it's very nice you can do the same thing with puppet you can again have local files in that directory or you can point a puppet server so if you're already using puppet to provision your infrastructure you can use your existing puppet infrastructure to do the same things run through that quite quickly but for me the advantages are you can minimise finding weird bugs only in production there's lots and lots of people here with Mac laptops how many people are using X-serving production it's like no one does it there are subtle differences that they don't catch you very often but when they do you've got a problem in production that you can't replicate luckily and finding those bugs is I'd rather do this than find running into bugs like that casing sensitive file systems if someone's going oh what's that read about casing sensitive file systems cos the Linux and Mac are different early and often testing of your configuration files if your sys admins do this at the end it's like anything that's just done at the end it's going to be poor if you can run through everything all the time it's like CI for your configuration management stuff excusable documentation is always better onboarding someone oh here's the documentation setting of the development environment that's only ever up to date the days after that person has started because they go through it doesn't work oh yeah change it doesn't work in a few weeks or months go by someone else comes in same problem excusable documentation that's run all the time will always be right and it leads to faster onboarding you can just go hey here's a vagrant file vagrant up download box chef puppet configure that machine bang they're up and running really quickly and they can be productive quickly even more important for contractors and there's a shared language between development and operations and that's important if you have two teams that have finished that was good no questions because that was 10 minutes if anyone's interested come speak to me about it I'm happy to show demo how I use it and the tool in front hello everybody so this is something a little different this is a productivity enhancement tool or a technique that you can use independently of the language you're using it's called top 5 and we'll see how why it's called like that in a moment this is 105 check so let me tell you a story at the beginning of the last century Charles Schwab was heading the Bethlehem Steel Corporation in the US the company was not doing very well and at that time Charles was hiring ideally a consultant for public relations ideally is known now as the the founder of what is called modern marketing relationship and ideally told Charles let's try something so I heard your story I think I know the problem so let's try to do this take this piece of paper and write down what are the 5 most important things you need to do tomorrow in 5 minutes Charles wrote down those 5 things then Ivy said well now prioritize them in the order that you think they are most important another 5 minutes pass it then the paper was ready so these 5 things were ready and Ivy said ok so first thing in the morning tomorrow when you go to the office start executing the first thing in the list that's all you don't need to think about anything else start executing and don't worry if you don't finish all the items in the list just try to finish the first one and start with the second one only when you finish the first one so respect the sequence of the things on the list in total this explanation was about 25 minutes and what happened was that after 2 weeks Ivy received a $25,000 check $1,000 for each minute that sort of consultancy lasted because those simple advices changed the future of Bethlehem Steel Corporation and at that time it became one of the largest independent steel industry in the US and Charles was a millionaire for that reason so he sent this $25,000 check back to Ivy Lee so this is the story of where the top 5 name comes from then in more modern time so this story has been told countless times blogs and books and in more modern times Cameron Harald rebranded this story or this technique to top 5 a few suggestions of how you can use it now other than that you are not allowed or supposed to put more than 5 items on the list this is very important is what makes the technique simple and powerful at the same time but you can use variation of it top 4 to 3 depending on the kind of work you are doing you can tweak it and try to understand what is the best thing that works for you maybe you should share this list publicly so other people can see it and you can feel the peer pressure to finish it to finish the items on that list and maybe you can expand this list to other time windows simple time windows like this week or this month or maybe this year so let's try to see an example of how you can use it top down which is in my opinion the simplest way of using it so let's say that this year I want to write my first closure application I'd like to run a marathon and I'd like to learn Portuguese so maybe sustain a casual conversation in Portuguese with someone what I need to do this month to achieve those goals maybe let's try to run at least 10 continuously at least 10 keys 10 kilometers maybe I can start attending the weekly local Portuguese meet up group where other people are talking the language I want to learn and I can maybe this month try to arrive and try to achieve the goal of running simple closure scripts then what you need to do this week to achieve those goals always not more than 5 or not more than 3 maybe I should read the first two chapters of the joy of closure maybe I should try to run at least 3 times this week and maybe watch a couple of movies in Portuguese and so what I need to do today finally well I can start by installing closure and REPL to do some experimentation I can try to run a 5 key and maybe I can start by learning the first 10 numbers in Portuguese from 1 to 10 so this is just a simple example of what you can do so the rules are pretty simple but yet it's so complicated why it's complicated because it's not easy to find out what are those 5 items that should go on the list and it's also not easy to find the correct size of those things so that at the end of the day you can have that check that green check on the item and you can feel that sense of accomplishment which is the main engine the main fuel that keeps you working then on the other items for this day, for today and for the next day maybe I didn't mention it but at the end of the day you're supposed to spend another 5 minutes thinking about what you want to do what are the 5 most important things to do tomorrow I didn't mention it was in the story in the initial story what's revolutionary if you want is that it's missing to the list huge to the list sometimes they become unmanageable too long it requires too much time to prioritize the item on the list because everything is in that list I don't know if you have ever experienced that and why it works because the brain is already automatically filtering to the list so you are perfectly able to forget what is not important to do and hopefully you will be able to remember what is important to do today and tomorrow so that should be easy for your brain to remember at the same time it should be easy for your brain to forget what is not important for the future that's all any question? I have a couple of minutes I have one there it's the same go ahead that is an expansion of the techniques can you repeat the question please? oh yes, you asked if this is if this going top down from the year down to today is part of the technique it's not part of the original story which is a true story but it's part of the extensions that has been added later by the ideas of Cameron Harold so yes it's part of the technique I think it's okay I I tend to do to put everything in the same thing because what I need to do today maybe it's part personal and part work that is the problem anything else? yeah not that long three months so it's not that long but I come from and I'm still using it other techniques so I'm quite used to learn these kind of improvement techniques and try to integrate them with my current workflow and maybe personalize them a little bit but it's not that long, it's three months and I'm struggling with it it's difficult as I said if you're quick I'm searching twitter hashtags and google for top five yeah it's quite new there's well there are really a few blog posts about it that's it there's a product I'm developing it's called teamlead.com and that is implementing this technique that is the other thing but other than that nothing else well it's it's against it because getting things done will try to push all your tasks or everything that comes into your mind into the inventory list and then try to prioritize them recursively so it's quite the opposite I would say we can talk it, yes thank you


Two, four. Seastown and New York. New York's tender on. Why don't they use the big guns to close it? That comes in play. Ironmore. Joe. Have an Easter message for the nation? Happy Easter to everybody. Happy Easter. What do you say, Brian? You whipped out on these, no. Happy Easter to the country. Happy Easter. Happy Easter. What do you say, Brian? Happy Easter.


It's a pleasure to introduce today's plenary session. So UIO is a WHO Collaborating Center for Innovation and Implementation Research in Health Information Systems Strengthening. And the tangible results of this partnership have been the development of health data content for DHIS2, which we generally disseminate through the WHO metadata packages. Some of you may have heard of these. So those who really know DHIS2, you know that out of the box, it's an empty shell. So you have to define all of the metadata that's in there for all of the different health programs that you need to capture and collect and analyze data for. So we've been working with WHO for the last several years to define a kind of gold standard DHIS2 configuration for health metadata. And we've been working towards this goal forever in mind with an integrated in-country HMIS. So a health management information system that has harmonized metadata and can capture all of this core data across different health programs. So this DHIS2 health content, we think it's even more than the metadata packages themselves. These can be installed onto national DHIS2 instances, but we really see this as an extension of WHO's work on developing health facility data toolkit and several other tools that are in their score framework that An will also introduce to you guys. So the partnership, WHO is technology agnostic, but DHIS2 is a platform used by more than 70 countries. So together we know that we can leverage this presence in so many countries to disseminate these global standards and to support the WHO's curriculum on analysis and data use. And further push ourselves as well to facilitate uptake with end-user training materials and with demo databases and system design guides that help us to disseminate good practices and how to do DHIS2 design. But also we learn from real-world implementations and we learn from all of the countries who have been out there implementing and designing and integrating their systems. So in the parallel sessions today you'll hear from a broad swath of our community of practice around how they've been using DHIS2 to meet health program goals for HIV, TB, RMNCH, immunization, other areas. But in this session we are very welcome our representatives, so Dr. Hong-Ang Chu, Aang, from the WHO headquarters, as well as representatives from the Lao PDR Ministry of Health, the Palestinian National Institute for Public Health, and the Rwanda Ministry of Health to share their perspectives on the journey towards strengthening integrated HMIS and adopting these global standards. So without further ado, I'm very pleased to introduce my colleague, Aang, from the Division of Data Analytics and Delivery for Impact. She's based in Geneva and she's the primary focal point at WHOQ for our UIO collaboration, which is continuing to grow. So she has a long history with DHIS2 implementation. She has been a champion for promoting the platform as a way to disseminate standards. But she also spent many years working in the Lao PDR WHO country office. So she is a steadfast supporter of making sure that we keep our global products and collaboration focused on meeting the needs of countries and helping countries to support their goals. So Aang, I will hand it over to you. Good afternoon everybody. Very nice to be back to be with the team and I'm very sorry that we will not be able to see everybody in person. Can you hear me well because we had some problem with audio earlier? We can hear you well thanks. Okay, so thanks Rebecca for the introductions and hello to everybody. It's very strange to talk to supposed to be a very familiar faces and we don't see anybody here and which makes me a little bit more nervous. So today I'm talking on behalf of the division of data analytics and delivery for impact, which is the new division in WHO. And I have a lot of people ask me the question, what is DDI doing? So we thought it would be a very good idea of taking this opportunity to give a very brief introduction of what DDI is doing and where we are in the collaboration in partnership with the DHHP, the diversity of all people. And to work on the strengthening of the health information system that most of all is to see how we're going to do together to support the country to overcome a lot of challenges by trying to reach the overall common goal of the universal health coverage and the health related sustainable development goal. So I am just trying to see how I'm going to do this. So let me start with this. I think on Monday when Dr. Samira Asma our director of the division gave the opening remark and one of her first things to say was that the high level that WHO together with all the country's state member to come up with the goal which is the triple billions. And out of that it means the entire world together we're trying to have a one billion people to be more benefiting from universal health coverage, another one billion to be enjoying better health and well-being and one more billion is to be more protected from the health emergencies. And that is even more relevant now with the ongoing pandemic which affects everybody in every corner of the world and that would also be something that we have to consider. And I think that is something was very relevant also on the presentation yesterday when you see how different countries will work together to try to control this pandemic and that will also affect the efforts of all the country put together to achieve this very ambitious goal. So the DDI was the that is the short name for the division of data analytics and delivery for impact. It was established aiming at supporting the organization to support the country and see how best we can trying to prioritize and support to strengthen the services in health sector but then through the evidence base which is this is why where the data coming in and this is why we are focused on in our divisions. There are three main strategies. Number one is to see how we can better measure to support the monitoring of the progress. How we're going to support the country to focus on what is the best way to prioritize to reach the results and how we're going to measure the impact. How we're going to support the internal building capacity in terms of coordination, get the governance side right and get all the concern party work together so that the country will achieve the target that contribute to the 1 billion or triple billions. For us what we're doing is that we have three four key areas that building into this strategy. Number one is to set the standards and also provide use of the the data available to get the estimate right so that the country can set up the goals that contribute to the three billion goals. Also we can only do that if the country have a robust and comprehensive and good health information system and through that is how we're going to work together how the data is going to circulate and use it collected and all of that through the data governance and exchange so that everybody will see where they are and how to get to the next steps which lead to the stock taking to see no that is all different milestones of measurement of the country. One of the latest external result of products that was published recently by the division is the score which is a the first for the first time is a very comprehensive tools that show represent all the different components that to build a comprehensive and strong health formation system. This and then the report of that will be released by the end of this year and this technical package that was launched last month has offered more than 90 different tools and technical guidance that help the country to see you know how best to strengthen the health information system and the HIS2 was mentioned there in several areas out of that they all focus a lot on is how to strengthen the data collection the analysis and also use of it to strengthen the routine health information system. Also one of the new features and it's being working on within our division is the World Health Data Hub which is the end-to-end data single repository that will help country to send the data regardless of different formats but the main point is that they go in one place but then it can be presented through different portals so one is for the country to use so the country share the data but also have the that can be they can also see the data through the old portal and out of that you know what is the achievement and the status of the triple billion will be reflected that there will be one stop portal for all data link to health that's sent to WHO and then there's be another portal that for you to go and do the analysis that is needed for your own use of all the country or for the program and then one of the work has been going on is the collection of the data catalogs and based on that we are trying to set the standards and the HSO will be one of those group of data metadata standard that's going to be in this data catalog. The other new feature is the mapping the GIS we just recently established the GIS center that aim a two purpose one is to work and support the Ministry of Health through our country offices to strengthen and use of the mapping for the country boundaries also for the health facility and be it as a part of the analysis to make better presentations of and visualisation for the own the outcome of the health sectors and secondly is to build a global database linked to the boundaries and the health facility so that it can be served as a base for any country who wanted to start you know to start to use mapping and location of health facility in the health information system. So having said that what would be the work of the GIS and the University of Oslo with the WHO as part of the collaboration Rebecca mentioned earlier in the opening speech and that was the work we have been doing in the last three or four years in terms of trying to build a standard for the data collections for the data analysis and the presentation of it through a set of dashboard standards that help country to visualise to to analyse the data better but also to for the cross analysis and comparisons and also for WHO it is a very it's a very good step to start for standardised data also for all different programme to work together and why we have to do that the latest world health statistic reports show that there are lots of countries that don't have enough capacity at the moment and don't have the available data to help them to monitor the universal health coverage and the SDGs so one of the core points and linked to that is we need to help the country to monitor which is the routine health information systems and the HS2 has been part of WHO to strengthen these three areas number one is to set the standard through the standard digital packages and to make sure that the data are harmonised and collected secondly is to help them in terms of strengthening the analysis link that with different other data which you will see later in the country implementation to see how does it fit in and help the country to monitor the triple billion targets linked with the other data sources and in the future how we turn that together and build the the part of the end-to-end data repository through the integration of different platforms, different programmes and also linked with different interoperability with the GIS with the ICD-11 with the logistic system and with the survey to make sure that the data is transparent and visible and accessible wherever the users are and the result is we have 39 countries have implemented this with the support mostly at the moment from Global Fund and Gavi which you have heard from the presentation yesterday and there are more and more partners who also wanted to support this and to see the benefits of having one single integrated health routine health information platform that share across different programmes, different partners and can be used across the entire country and so far we have these many products and the latest one was COVID which is developed in a very interesting way which I hope you heard of it yesterday I was really impressed how it was developed and made into available through a cohesive and very and cooperative way by many different players in the communities and how it was rolled out so fast in such a short time. We have a more in the pipeline and moving from aggregated reporting into a case by retractors but also one of the things that coming up a lot recently is the community health information system as one of the core points for the primary healthcare which is essential part of the universal health coverage and how do we work together we have the WHO mostly but also UNICEF and other the technical partner contributes the technical guidance for the agnostic health data collection and analysis standards and we have the DHI community help in terms of making it into a digital data package that can be implemented in the countries and adapted in the country so that it not just meet the needs of WHO but more importantly also meet the needs of the country data requirements and then I think also one very interesting feature is the network with the health data collaborative where all the partner work together and support the country implementations. How do we do it together we have come up with a very simple cycle which go through development testing implementation lesson learn and then go back to the improved movement and then we start with WHO or technical agency and then from the second phase we work hand in hand with the University of Oslo aiming at strengthening this package and make it as user friendly as possible. So this is what we do we work together we're trying to put country at first make sure that it is usable it is useful it is supporting the implementation but the capacity building in the country it has a feedback loop so that we always learn from our doing and then this the the improvement and strengthening of that is continuing process so just a simple key message here we need to have a clear guidance on the how we how we use the data what data is needed putting the country at first for the user perspective then we need to make sure that there is a environment that supports the implementation and the use of data strengthening the data quality the governance of data make sure that there is a privacy there is a confidentiality and and and security for whoever use our system and then and last but not least is that you know it doesn't matter how strong the software is our WHO and now our DHI's who call it also need a very clear standard need a very good communications and a unified common guidance that we work together so that country can have the same message and they can make the best out of this with our lots of confusions which we come up sometimes and the need to work together to strengthen the capacity in the country so that was a concept and for the next it was how it works in the reality and I'm really looking forward to listening to how our friends in Palestine and Rwanda are making this into reality thank you thank you Aang and now I'm pleased to introduce Khadija Abu Khadir from the Palestinian National Institute of Public Health. Hi Rebekah hello everybody nice to join you this session and hope next year to be face-to-face inshallah I will share my screen so we can you can see my presentation. I will be presenting the Palestinian experience on behalf of the Palestinian National Institute of Public Health we are the Palestinian Institute of Public Health we are one of the WHO project that have been endorsed by the Palestinian government and the president to be an independent governmental entity and evidence-driven institute that aims to improve the health and the well-being of the general public in Palestine we are working closely with the Palestinian ministry of health our colleagues at the Norwegian Institute of Public Health and other partners from University of Oslo HDI as to health and community okay so the NIH since its establishment has been working heavily with the stakeholders to strengthening the essential public health function and the health system in Palestine through providing accurate and reliable data and evidence-based information creating an integrated and sustainable HIS that collects all information health information in one system enabling easy access and better overview of health within the country is our vision and would be an appropriate tool to reach the goal so our condition in Palestine regarding the HIS before our working on this field we have unfortunately a limited functioning HIS where there was a health information system in hospitals which started in 2009 and currently is running in almost all government and hospital and only four health directorate out of 13 having this HIS in addition to only four clinic out of more than 400 the clinic also having the HIS unfortunately we can notice that this HIS was failed to be scale up or to be sustained in addition to the lack of proper technological solution and the resources constant so at 2017 we started our experience with the HIS in Palestine with the national implementation for a customized tracker of interactive checklist and decision support system and this has been implemented in close collaboration with the Norwegian Institute of Public Health and University of Austin starting from this point we have noticed at the NIH and Ministry of Health that the HIS is will be a good HIS tool and software for the Palestinian context as being able to be customized for our need and for our health system needs so the BNIB has invested heavily the capacity building of Ministry of Health and BNIB to until we succeed to establish a national country team with a member from both BNIB and Ministry of Health that have been with wide range of specialties and capacity BNIB tries to provide every learning opportunity for the team to master the skills and the knowledge that needed to maintain and to develop the HIS program in Palestine and actually the team were able with the remote support to develop to customize the first HIS aggregated system for most of the primary health care report and statistics and this is only was the beginning then a tracker program which is patient based tracker for the case-based surveillance and for mammography also was another achievement for this team the big achievement was within system that we were working on to integrate the NCD and to have a unified patient record where all primary health care services have been integrated in one electronic record and with avoiding the verticals program to track patients from P and registered on birth registry till death register even without the break of Covid which is started in Palestine at March 2020 the team managed successfully and we are proud to say that in a short notice to develop a COVID surveillance package according to Ministry of Health needs and WHO packages and may end up finishing for that could be positive and confirmed cases so this slide you can see the graph that show the current ongoing irregisteries and computerized program in Ministry of Health the primary health care clinic you can see on one of the side we have the mch irregistery which is customized the tracker virgin 2 by 2.29 you can see at the end of the graph also we have the HMIS and in the middle you can see the standard tracker that have been built by the national team all of them are in 2.30 and they are in the process to be updated 2.32 unfortunately we noticed that there are a limited so I'll move for the next slide which is show the ideal vision for the primary health care e-health application we are looking forward to have this graph on the ground where would like to have an ideal virgin where all registries have been interacting with each other and there will be like a master registries to be synchronized with all other trackers where essential enabler data will be exchanged in unified format so we can notice that we are planning to have a free master registry and actually we will succeed to have at least two of them the facility registry that contain all facility in the primary health care and we have the HMI as we are ready and now we are working very well on doing the client registry all these standard tracker and there will be like an in a data exchange and in the integration with these registries in order to be able also to interact on to do integration with outside ministry of health HMIS and health information system such as the BCDS and other health system and non-health system in balistar okay so how we were working during our work with the main partner the ministry of health and other partner we we were able to to approach ministry of health in different way the first approach and the third mechanism that we were heavily investing in is the building the national capacity in the HIS too that would enhance the developed HIS and to ensure the sustainability so ministry and other partners would feel the sense of being always being able to be supported they will be able to maintain the developed HIS and they will never left behind it's very important so that they can be committed to the developed HIS and other programs other approach that we use with the ministry of health is the implementation phases we never went for program in one time we depend on the gradual phases in implementation where we do sometimes piloting test then go if the the program was working well on the real and on the ground we go for the national scale up this is very important as this will facilitate the change management the process and the adaptation of the ministry of health and the systems user to the new technology and to the system another important point that we were relay only during our working with the ministry of health to strengthen their health system is the clear requirement where we usually develop for any developed program we prepare a clear requirement and we share it with the related technical units starting from the minister from the deputy to the technical unit and even sometimes with the end user to make sure that these requirements are matching with their needs with a satisfying flow of work and this is very important as it would enhance the ownership and also the open and active communication listening to the partner especially ministry of health needs being frankly and honest on what the HIS do and what develop system can do and what cannot do it's very important this is with help to have trust relationship and this is with also help us in providing a continuous feedback for the ministry of health and for the partner to make sure that we are working on the same ground and we are doing what they are expecting so we will not be surprised or the minister of health to be surprised with an expectation that did not come to the mind of the developer or so looking to the factor that's contribute just a two minute warning thanks yes okay the contribute to the success of the work in addition to what I have mentioned I would like to hide that the health strategy initiative that is going down in Palestine and it help us to have a commitment from the ministry of health to to be able to implement the different health I would like to go to the last slide in my presentation which is the future perspective continue our work with the ministry of health to strengthen their system we are planning to focus more on the stability and further growth for the HIS to platform we are planning to include more health services that have not been part of the health system till now such as the mental health services and the school health and a major issue also we are focusing on is the integration with other non-governmental health sector we have started with the with the ministry of women's affair we succeed to have national observatory for the agenda-based violence and we are planning to move for other organizations such as ministry of education ministry of anterior and the party of Oslo and the HIS for better outcome and for better strengthening for the health system I will stop here Rebekah and other colleagues and I have to thank here the BNIBF team without their dedicated work none of this would be achieved and a special thanks for our colleagues from Oslo from you know you know in Norwegian Institute of Public Health and we would not forget our colleagues from HIS for their generous support and cooperation thank you thank you so much Khadija for for sharing all of these hard-earned lessons learned and I do hope that the strong foundation of the HMIS lets you reach to your ideal so we'll keep learning from you in the years to come Dr. Chonsili and our Lao PDR team the floor is yours I'm sorry I should introduce I'm sorry Dr. Chonsili Pomavang he's the deputy director general for the department of planning and cooperation at the Lao PDR ministry of health so welcome Dr. Chonsili. I think you have to share your screen to slide. Okay can you hear us? We can. Okay so uh I just would like to start our PowerPoint please not go why? Okay so this is the first presentation that the topic that we are going to cover during these 10 minutes mainly talking about the what we have done and what future we are going to do and I just start what begin by the uh overall what we have done in in the past so far the SS2 has been already started since 2015 and 2017 it's already become the connection of the integration platform to the whole country so far we already trained more than a thousand staff for the training staff on not only for data and papers but also for using the system managing the system everything and so far only 14 key health program has already been integrated into the into the SS2 system so that we can see it all and more than a thousand two hundred health facilities meaning including the central and hospital and provincial and district and health center already using the data and the data into the system and so far we we checked the automatic reports so far already 90% reporting completed also very good there the second thing it now we already has already integrated many programs into the system but we call more than about 40 programs are already integrated into the system so we apply our free function of the SS2 both including aggregate event capture and tracker because so we can see here some program has already on on on using only aggregate and event capture some program already still mainly event capture and so far we already have one program like a logistic management information system have only interpreted with the SS2 and we we still have about free program that you need in the future with the internet into the system mainly for the health insulin the hospital information system or EMR and so the the hormone resource information system will be later on integrated into the system but mainly we cover the key program that requires for the government checking tracking indicator so this is the main integrated into the system in in law so what so far ongoing the system that we are doing now so for the SS2 we use not only for collection of the number or code we also extend to the to the quality of service meaning that we use the system to to track the the quality of service at the hospital and we are now already customize the quality scorecard into the tablet so that we can the health center or can check the center level can check the quality of service of the health center and health facility we also include also clinical variant meaning that the how how the the health staff perform using the distance to modern to to to check the quality of the staff who are performed the the treatment of the of the of the disease in the hospital we also improve improving the quality of data aside from the we have a normal system already in place like a mark mean or well it is a good news i have the the the quality checklist on tablet to capture data or this is mainly for the for the epi data right also the we have a system cooperation between the survey data and routine data the interaction of the unicef global for the SS2 we're also using the system to monitor the disbursement link indicator which is funded by global fund and and and and the world bank to track the indicator that later on you you can link to the payment without this this is to the the world bank global cannot cannot proceed the program because even based on that to verify whether the system and and the actual information is is included we also used indicator to to monitor the quality of the quality of care for nutrition financial information system and also other program like history tv and and the e-pay service so we know the also integrated data from other sector to the to the to the main hsms because of we now we also integrate of the climate data into into into the system we can link between two information to to to monitor the to inform the decision maker where it's needed to to her and also the data can be shared with the noted with the minister of whole fair mainly on the mortality of the children mortality the marketing and marketing so that we have already have agreement any information from yes so we can share with them and any information that they have from the system from moha can save us so we also have the innovative approach to strengthening even basis serverland so we have used the serverland function of the desert to to to develop a cup to information from hotline called easy serverland we also strengthening the the company data from community service for strengthening of serverland system we also expanded the not only the facility based information also extended to the community based information we are now collecting information that is not collected from the looting information like water supply and also the the company planning for detail and also the helping solar and so more finally we formed the committee based on when we got the the ryan population cow meaning the the ryan number of target population that we we used to calculate the the main indicator so and so we as we said they very use the we customize the tune like the way so data quality assessment tune immunization data analysis tune and so also the dashboard for the covid-19 which is really useful information so what are we already adopting global global standard of integration for his or her the first thing the lab adopt the standard the user tools such as the uh the dark quality tune immunization analysis tune we also have used the adopt the customized standard packet of covid-19 as i mentioned before during the covid-19 only our system can provide interesting information for for the covid-19 tracking we also use the standard report for generated this is specific system for example for tv sv malalia which is very standard so that they can report not only to the country but also report internationally to the wso to other thing we because of the standard because of the that the reporting already standard also we are working also with the national uh digital health guidelines standard to ensure the interval over the years of continuous we've got the continued support from the way so to the loud team we also got support from you know also the health health information system in vietnam also standby anytime that we need them they just provide the support technically support for us so as i said that we are working uh with the partner we are not only minister of health alone but also working with different partner like a global fund word bank adb lots of work and many partners putting funding together not only the funding is also technically putting together we also have a legal partner coordination meeting talking about health information system we update we legally review the system review the how how people using the system to to monitor the indicator how people using what is challenging what is the benefit from that holding the legal meeting we also have one system one door system that all information all information all the design or development of the form should be gone to the our this is to team we also have the uh one detailed plan we need the plan including all the partner in the end including also government the different partners like uh word bank and adb global fund we know the all activity we also use the funding to sustain this because the ui and this much of a link together provide really sustainable funding to stimulate the the health staff to to continue working on the quality of the health information system and also part of the national global health strengthening initiative dr chopson li i'll give you two minutes for yes yes i this is the last uh power point so aside from success we have also the challenging for example first itself about the the use of information anyway we have no matter we have a good quality of data but people didn't use it not uh it's not good so yeah so uh many people still not understand the whole concept many people use the system but some people use uh the system they tell us whatever they want to do but some system cannot function to to provide uh what what they need also the data quality needs to be strengthening we need to strengthen the ownership of the people who are using the system yeah so uh so the key lesson learned we have to first of all we have to have a very strong uh leadership on also we have we have to have the the strategy to guide the uh to to involve all the partnered to put the to investment into the system and to make the system more functioning and certainly so this is the uh in the future we are still we will continue to to to uh working with the hospital information to integrate to the system also in the property with the other system that's not uh it's not in the system yet this is my last power for you so thank you and any questions you can have thank you so much dr chanceli i think it's just really impressive for all of us to see how much you have achieved by having a common plan and a common investment framework and now being able to push into um some really innovative areas with the end supply integration and working across sectors so it's my pleasure to introduce our last speaker it's um andrew we're here from the rwanda ministry of health um andrew if you would like to share your screen um thank you rebecca and um okay good so um my presentation will much more focus on the renders approach to strengthen hms and adoption of the blecho standards without taking much time we currently we have one integrated system in rwanda that collects all clinical data from all health facilities uh so this is the background uh we uh mostly in before 2011 we had the system that was uh no offline system but uh in 2011 we managed to move from the offline system to a web based system so the main the main aim of moving was the fact that the system was really not easy to to maintain and it was a little bit complicated so in 2011 we reviewed our tools you can see it on my powerpoint we reviewed all our tools and harmonize our reporting form and we developed also sops to ensure that the new system has all needed uh materials that standardize their data management across the facilities then in 2012 we launched the web based system uh 2013 we worked around uh indicator manuals and ensuring that everything the definition is well everything is well defined uh then 2014 we implemented the etb which was the first case-based system in to be implemented in rwanda then we continued 2018 and 19 where we've been working with blecho to implement the data quality tools and then ap tracker so these are the standardized documents that we developed in data management we have sops we have data collection tools we have indicator reference manual uh then these are the packages that we already have in place now we have uh program routine clinical reports that are reported directly from the health facilities then we have case-based like etb ap tracker and mccod that uh you know medical certification cause of death all of these are the blecho packages then we have annual reports daily flash report from the from the from that helps the high levels from the ministry take actions real-time action we have disease surveillance then we have performance even best financing then covid-19 as we as i presented yesterday then the data quality mechanism because all of above cannot be really useful when we don't have the mechanism of data quality like many other countries we work with the dp which is the development partners to ensure that the data we collect is of good quality so we have what we call integrated supportive supervision that uh that brings together multi-discrimination teams including partners and uh also uh i would like to appreciate the the the contribution of who in this process so all of them they come together then they take data from the hs2 then they go down to check if whatever is in the hs2 is the same as what we have in the system or what we have in the source of data so this one also contributes a lot in terms of data quality and also confident when we are taking a decision on our data so uh we have decentralized monthly data validation also that also contribute a lot on this this is an example of the monthly data validation meetings you can see that the health workers on monthly basis they they meet and they check the data before it's reported in hmis but again we also have another meeting that they do to to discuss on their indicators and the health uh their indicators and whether they are moving up or down so this is the data use monthly meeting that i was talking about they when they discuss it's it's always shared by the head of the hospital remember that at the hospital it has the catchment area of the health centers so they discuss and they try to come up with interventions but all of uh intervention are based on the data so they present directly from the hs2 then they they take actions based on what data says from their catchment area i always give an example of an increased malaria that we we had this specific period of time then there was a there was an intervention that the government says those people from the this category they have to be subsidized then the community workers also have to consider adult for treatment but all of that was from the dhs2 so how how are we using these packages because we already have the framework of data management in in place but what we did in 2019 was like changing most of our tools to ensure that we institutionalize or we accommodate the new tools because you know most of the time we promote information used but when we don't have robust tools to ensure that people are able to visualize data they're able to visualize errors and outliers so that's where we we really uh we installed with m o m o and u i o and double h o we joined the efforts and we managed to train our people and we installed the double h o data quality tool and this tool was also institutionalized because you know we changed our sop when we shared a link our sop is version 2019 so it really accommodated the use of data quality tool and this one has really contributed a lot because it's very easy for you to track the outliers during the data checking and data review meetings so we also have the program level dashboards you can see that on my dashboard there with tb and tb notification and deliveries some of these most of these dashboards are from packages that we really installed and we tried to to to customize them based on the program needs and the facility needs so uh for sustainability we always collaborate with our partners but also um we've been really working closely with double h o to ensure that our teams are also trained uh with uh collaboration with double h with uh universal or slow we managed to have a pool of experts in the country to ensure that whatever we are doing is not based on one person but is based on the pool of people across the country so that whenever time we need we'll always have experts of people around to support the system so we are now introducing the use of e-learning as part of uh uh mitigating the the the covid situation but also uh some funding you know that uh training is expensive so we are now using e-learning to train our people we have managed to train everyone on their data quality including the double h o data quality app so now we are also adding other contents trained online so the condition of these packages and dashboards and dhs too is really wide but i wanted just to highlight a few of them there is a policy and strategy decisions uh has program planning these are more resource managed resource management capacity building and others so future plans because you know even though i'm presenting that we have these tools we are not where we want we are still need to to join efforts with our partners and everyone to ensure that you promote the information you use at facility level and district level availing data use tools to users e-g double h o packages capacity building to all users uh these these the areas of these are the areas of focus you can i didn't want it to write then the bullet points you can we can see it from the system the favorite views you can see that obviously our system is telling us the dhs too is telling us that most of the people are using pivot table and shots so we need to put much efforts on the dashboards we need to put much efforts on other analytical objects like maps and others so this is the link of to our tools that have been presenting SOPs and your statistics booklet and others thank you this the end of my presentation better information better decision and better health so for any questions please post it on the commuter of practice thank you thank you Andrew that was amazing and i particularly like the slide on on data use and being able to leverage that framework for for data management i also think we're pretty excited to see what you all do in terms of e-learning for covid um we have maybe three minutes so maybe can only take one question um on there was a question about um how to actually support data use so once databases are set up in countries and they have more of the standards um how do we ensure that the data gets used and i think on or if another presenter would like to answer that question but then we'll move everything else to the community of practice which i have posted in the chat okay hi hi Arthur thanks for the questions um i think if you understand it correctly it's about you know the it's about the data lake concept if that's the case it's the whole point is that it should the whole data lake concept is to ease the way the country share the data and then to and then it should be made available and accessible to all the country to use it but of course to show it on the on the internet it doesn't mean that it's going to be used and then that is you know in the name of the division there is the department of delivery of impact where they are actually doing uh lots of estimates and then work with the country to come up with the targets for different countries and then every three months they take a stock tax of you know how far they have gone and then use these portals as a way of showing how far and and where the country goes and then and then trying to to work with them to to make use of the data and then collect the data again so even a circle but it's what it's more important and it will need further strengthening and and and collaborative effort to support the country is to set up a proper data governance with focus on the data use to strengthen the data quality and also to build the capacity and I think that is where the the DHS to standards with the integrated platform plays a very very important roles because it already has a lot of engagement from different programs and and then have more interest in that so we can talk more about this but I'm very much aware of the the time and please feel free to contact me any time over. So thank you Aang and also thank you very much Khadija, Dr. Chansali and to Andrew for sharing with us your your country experiences we look forward to following your continued progress over the years and at this point we will stop the recording and get started for the next session. Thank you all very much.


Learn versus study. Do not say. How long have you learned English? Say instead. How long have you studied English? What's the difference? Learned implies that you're finished. You don't have to do it again. For example, I learned Chinese as a child. I'm done. I'm a native speaker. Studied can refer to an incomplete process. For example, I studied Chinese in high school, but I didn't get good at it. Other differences. Studying usually implies book learning. For example, I'm studying geometry this semester. Learning can be any skill. My son is learning to ride a bicycle. Avoid using learn to describe ongoing, not yet completed processes. For example, I have learned biology for two years. No, that's not good. It's better to say I have studied biology for two years. To learn more about this topic, see video at link. Or check out our websites for more free English learning resources. www.eslgold.com or freeenglishstudy.com


Dear students, in this topic we shall discuss the role of acetylcholine and catechol amines on excitation. Dear students, first we shall study the effect of acetylcholine on pacemaker potentials. The parasympathetic cholinergic fibres of vagus nerve that is 10th cranial nerve inner weight, the sinoatrial and atrioventricular nodes. From these cholinergic fibres acetylcholine is released. Acetylcholine slows the heart rate. This action of acetylcholine is known as negative chronotropic effect. Acetylcholine produces this effect by increasing the potassium ion conductance of pacemaker cells. The flow of potassium ions keeps the membrane potential near the potassium equilibrium potential for a longer time. That is why the actions of acetylcholine slow pacemaker depolarization. So the interval between the action potentials is increased. Acetylcholine also reduces the velocity of conduction of excitation from atria to the atrioventricular node and from atrioventricular nodes the acetylcholine slows the excitation of ventricles. This way acetylcholine has three types of acetylcholine, action potential length, number two, atria to ventricular node excitation transfer and number three, atrioventricular node say ventricles that excitation key transmission in tino processes co-slow kati hai as a result it slows the heart rate. Dear students, now we shall discuss the effect of catecholamines on pacemaker potentials. Sino-atrial node, atria, atrioventricular node or ventricles in tamamke under adrenergic nerve fibres innervate kartei hai. Hidu adrenergic nerve fibres hotei hai, they release norepinephrine, which is a catecholamine. Norepinephrine increases the rate of contraction of myocardium. Ye heart rate ko increase kartei hai. It increases heart rate by increasing the conductance of sodium and calcium ions. The sodium and calcium ions accelerate pacemaker depolarization, norepinephrine also increases the force of contraction of myocardium. This effect is known as positive ionotropic effect. It also increases the speed of conduction of wave of excitation over the heart. This effect of norepinephrine is known as positive tomotropic effect.


I appreciate it, Sergeant. I'm going to talk for a few minutes, and then I'll be happy to answer any questions. And if anybody wants to stay afterwards, take a picture, text it back to your mom, show that you're actually at work today, and what you're doing, I'll be happy to stay. What the United States Navy and the United States Marine Corps provide to America is presence. We are everywhere, not just the right place at the right time, but the right place all the time. We give leaders options. We give the president the option, whether it's disaster relief that you saw in the Philippines, and we have Marines there a few hours later, or whether it's high in combat, whether it's irregular warfare, or whether it's partnership building. If you look at the defense strategy, that was announced by the president two years ago this month says, concentrate on the Western Pacific. Concentrate on the Arabian Gulf. Concentrate on building partnerships. You just had a definition there of the Navy and Marine Corps. 21st century is going to be a maritime century. And the Marines are America's crisis response team. Marines do for this country what no other fighting force can do. This is the most formidable expeditionary fighting force that the world has ever known. And we've got to make sure that all the challenges that come out of us, that we keep it that way. I try to organize my thinking and what the department does around four P's, people, platforms, power, partnerships. We've got the best train, the best, the most skilled, best educated force we've ever had. Y'all are rightful heirs to the long, great legacy that the United States Marine Corps has established. I got back not long ago from my 12th trip to Afghanistan, where Marines have fought incredibly well for more than a decade. And Heltman's going to join the names of places like Tripoli, Bellowood, Tarawa, Chosen, Way City. And that's a legacy that has been bequeathed to you and it's a legacy that y'all are upholding so well. But we're coming out of two land wars. We're out of Iraq. We're drawing down in Afghanistan. And the Marines are going back to sea. Going back to your nautical roots, Marine Corps is going to get smaller. We're trying to do that in a way that doesn't break faith with Marines, doesn't break faith with families. And we're trying to do it in a way that positions a Marine Corps for what's coming next. Marine Corps has rebuilt the Marines from the ground up during this drawdown. Marine Corps is America's crisis response team, the force in waiting. We're ready, not just on day one. We're ready on day zero to do whatever needs to be done, wherever it needs to be done. We're expeditionary to our bones, part of our DNA. We understand that tempo that we've been going on, whether for args or for deployment to combat, has been really high. And we understand the pressures that that puts on y'all and on your families. And I hope that we can get to a more regular rotation so that you and your families can plan better and that we can make sure that we have the resiliency to keep this force as fine as it is. We try to provide you with the best platforms, best ships, best aircraft, best weapons systems so that you can do your job of protecting this country and standing in the watch. I'm really proud of what we've done, particularly in shipbuilding. On 9-11, 2001, United States Navy had 316 ships. By 2008, after one of the big military build-ups in our history, we were down to 278 ships. In the four years before I took this job, the US Navy contracted for 19 ships. In the first four years I've been in this job, we have contracted for 60 ships with a smaller top line. We're going to get the fleet back under the current plans to 300 ships before the end of this decade. And that has big ramifications for the Marine Corps because we're building amphibs. We're building the ships that the Marine Corps will need to make sure that you provide that presence. And part of it is how we get and use energy, the power part of the fleet. We're moving from fossil fuels to alternative fuels for one reason. That's to make us better war fighters. Make you better at what you do. In the last two years, fiscal year 11, fiscal year 12, the Department of the Navy got $2 billion in additional fuel bills that weren't budgeted. That's because the price of oil has been so volatile. Because oil is the ultimate global commodity. And even if we can produce all that we need in the United States, it's going to trade on fear and it's going to trade on rumor. And so when something like Syria happens, price is going to jump up. It's going to cost us money. And there's not many places to go get that kind of money. We can get it out of operations. That means you train less. We steam less. We fly less. Or if the bill gets too big, we build fewer ships, fewer aircraft, fewer weapons systems. I don't think either one of those is a very good idea. So we're moving, changing how we use, how we use, how we get energy. And the Marine Corps, as the Marine Corps always is, has been at the forefront of that change. During the height of the fighting in Afghanistan, we were losing a Marine, killed or wounded. There were 50 convoys brought in. And most of those convoys were fuel. That's too high a price to pay. We've got to change that. And finally, partnerships. In four and a half years, I've been secretary. I've been 800,000 air miles, 107 different countries. Vist and Marines, sailors, where they're deployed all around the world. Now, Vist and Marines in Mongolia, I Vist and Marines in Burundi. I Vist and Marines on Args off the coast of Malaysia, building partnerships, training other militaries, teaching them how to fight, teaching them how to do the things that militaries need to do. And nobody does that better. Nobody does that partnership building better than the United States. Marine Corps coming in off Navy ships, we don't take up an inch of anybody else's ground. We don't take up an inch of anybody else's sovereign territory. We come in on American ships. We leave on American ships. I wish I could give you some certainty about what's going to happen in Washington, particularly on the budget. There was a budget agreement made in December that covers the rest of this year of 14 and FY 15. And it's a good first step. It allows us to plan a little bit. Because the way we were going, sequestration, continuing resolutions, because budgets aren't getting passed on time, was just causing us. It was mandating us to make bad decisions. We weren't able to put money against strategy. We weren't able to put money where it was needed. Everybody knows that the American people have a right to expect that we're going to spend less on defense as we come out of two wars. But we ought to do it in a smart way. We ought to do that drawdown in a smart way. And we ought to do it in a way that gives us some certainty so that you can plan, so that we can plan. So it's a good first step, but it only goes through 15. And that's about a year and a half from this. It has been since 2005 that Congress has passed a budget on time. And these continuing resolutions are almost as big a problem for the Navy and Marine Corps as sequestration. So we've got a little certainty next year and a half. But tremendous uncertainty past that. You deserve more certainty. You deserve some more stability in where we're going here. Greatest honor in my life has been to lead the Navy Marine Corps. You are the indispensable force for the country. The country has to have you for presence. The country has to have you for crisis response. The country has to have your skill, your training, your education.   You're who people believe about America. We've got the best force we've ever had. But we've got some risk in this force. Now, I talked about the high operations tempo. Some of the stresses that are put on families, but there's some other risks, too. Sexual assault is an attack. And it threatens to undermine the fabric of the Navy and the Marine Corps. You raised your right hand and swore to protect and defend the Constitution of the United States. You also are promising to protect and defend your shipmates, your fellow Marines. But sexual assault is an attack. Somebody was walking through Camp Pendleton taking random shots of people. We would do something about it. Sexual assault is the same thing. It's an attack. It's an attack on one of your fellow Marines. And we have got to stamp it out, or we risk a whole lot in this Marine Corps and in the Navy. America for 238 years has depended on the Navy and the Marine Corps. They've depended on us for presence. They've depended on us for options. And we have delivered for 238 years. We have been the best option for America. We have been the first option for America. The next years, the next decades, will be no different. When you are doing your job, when you are far deployed, you're almost always a long, long way from home. And the American people don't get to see how good you are, how skilled you are, how hard your jobs are, and how dangerous they are a lot of times. And they need to know that. They need to know what a great force the Marine Corps and the Navy provide for them. Fewer than 1% of Americans wear the uniform of this country. But you protect, you defend, the other 99% in a professional and awesome way. So on behalf of a country whom you protect and you stand the watch for, thank you very much. So Marines, sailors, Semperphi, Marines, Semperfortis, sailors, who raw? Who's got a question? I do, sir. Hold on just a second. Stand back up. Stand back up. First question gets coined, but only the first question. My name is Lance Corporal Ossani. I come from 939 National Archaeology. My question was about the tank. Now, I know there's some trouble going on in the Northwest of Sioux. Our air station in Futima got taken over. And I know there's more trouble going on. I was wondering if there's more trouble that's going to go on to open up. Fair question, Lance Corporal. We've had an agreement with the government of Japan to move Marine Corps Air Station in Futima, move it up to Camp Schwab, further north in Okinawa, away from population centers. It's been going on for a while. The governor of Okinawa just signed the document, the environmental document that's going to allow us to begin to make that move. Now, it's going to take several years. But it's part of a bigger move whose we'll still have about 10,000 Marines on Okinawa. We'll have a few more than 5,000 Marines on Guam as part of this move. We'll have a rotational force of about 2,500 Marines in Darwin, Australia. It's part of the re-battles to the Pacific so that we have Marines west of the international dateline. We have Marines. We have an ARG in Sassebo, Japan that's going to be out and about through that area. And the Marines, as they rotate down to Darwin and to rotate into Guam, are also going to be doing the exercises, doing the partnership building throughout Asia. So we've had a presence, Navy Marine Corps, for decades now in the Pacific. We are going to have even more of a presence in the future. And as I said, once the governor signed this paper, we can now begin some of the move. It's going to take, it's going to be a few years. You'll be at least a gunnery sergeant by the time all this gets done. But at least we're moving. Who's next? Morning, sir. Good afternoon. This is your first spring division. My question to you is, with the war winding down and the pivot to the Pacific, are there any plans in the works to make amphibious ships, to increase the availability of amphibious ships to the Marine Corps and onto the sailor's gear for training? We are building amphibs. We're building to 33 amphibs, which is what the Marine Corps needs. That's sort of equally split. 11 big deck amphibs, 11 LPDs, 11 LSDs. We'll have nine, don't need to check my math here, but we'll have nine three ship args. We'll have one four ship arg, and then we'll have a big deck amphib, and maybe one other ship available for tasking wherever it's needed. And so I think the short answer is yes. Because we always now have an arg somewhere around the Arabian Gulf, somewhere in the Central Command that's out and about. We always have an arg in the Pacific that is deployed. And we've got the arg in Sasebo, Japan, that's the four ship arg that's home ported there. For Marines and Navy to do what we need to do and to keep the rotation, to keep the ships that we need to build to that number. And the Chief of Naval Operations has said, and he says publicly and so do I, that one of our highest priorities is building amphibs, and keeping amphibs in the fleet so that we can make sure that we do the marine missions that we have. Thanks. See us to the point in the future. I'm going to give you a non-specific answer wherever we need it. Hi, sir. Some again, Marines. What are you for? Sir, I am from Ackerman, Mississippi. Woo! Now, the reason that's important is that I am from Ackerman, Mississippi. Ackerman, Mississippi has about 1,200 people on a really good day. But it's a county seat at Choctaw County. What's your name? Mom and Daddy, I ask about them. Who's next? Go right on, we are here on the Afghani task fraction. And we've been out for about a decade and about a year and a half. What is the purpose of that, that's the right answer? In the Afghanistan, because that's where the people who attacked us on 9-11, that's where they trained, that's where they came out of. What we're trying to do and what Marines have been magnificent at, we're trying to make sure that Afghanistan can never be the haven for people like this again, trying to make sure that Afghanistan cannot be a breeding ground for terror to either threaten its neighbors or to threaten us. Marines, particularly in Helmut, which is where most Marines have been, have done a great job in creating a very stable security situation there. Over the last couple of years, as we begin to draw down, the Afghans have begun to step up. The Afghan army, the Afghan police, national police, Afghan local police have done a pretty good job. They're in the lead in everything now. We're negotiating now about what kind of force to leave behind. And it's going to be up to the Afghans to maintain that security. But the Marines, I'll just speak about the Marines and the sailors who've supported the Marines in Helmut have left them one of the most stable security situations anywhere in that country. And we went into Marjah in 10. It was one of the most violent places that there was in Afghanistan. About a year later, I went to Marjah and walked to the market. That's how much the situation has changed, and whether it's Marjah, whether it's Nalzad, whether it's anywhere in Sangin, Khajiki, in the very north, Marines have done just an incredible job. And now the job is changing to mentoring, to training, and to pulling back in terms of letting them take the security lead. And so far, at least in Helmut, they've done a great job. Yeah? It's regarding a recent budget that was passed. Do you see further cuts to veteran and retirement benefits coming? And if so, would that not be breaking the state of the current inlisting and efficient Marines and sailors? Well, first, the budget that got passed wasn't a cut to retirement. It was a slowdown in terms of the cost of living increases that retirees were getting. Second, if we don't get a handle on personnel cost, if we don't do some things here, what's going to happen is there going to be a lot fewer people, a lot fewer Marines, a lot fewer sailors. Because the only way to offset high personnel cost is to have fewer people. And I don't think that's a good idea. Now, in terms of retirement, there's a commission looking at types of retirement. Whatever system you joined under, so the current system is what you're retiring under. There won't be any change for anybody on active duty. There may be a change. There may not be a change for people joining later. Don't know that yet. But on stuff like working-age retirees who have retired from the military, have another job, can get health care through their employer. Tri-care right now, which they're eligible for, cost about $500 a year for a family of four, a civilian, working for the government. Pockets about $4,000 to $5,000 a year. The health care cost is the same. It's depending on who picks it up. It proposed is to ask people to pay a little bit more of the true cost of health care if they are working-age, if they're retired, and if they can get insurance somewhere else. Now, we're not asking to pay the same amount that civilians pay, nowhere close. And we're tiering it so that depending on what rank you retire at for your retirement, the lower the cost would be. But if we don't, if we don't do something like this, we are at the point now of having to choose between getting you the tools that you need to have and having the force that we have or continuing to give retirees an incredible deal, an incredible deal that was never part of the original contract. Tri-care is only, this tri-care benefits only been around since the late 90s. And it was put in, my understanding it was put in for people who couldn't get insurance through work when they're retired. But if we don't, if we don't attack these things, if we don't do something about it, if we don't stop this huge growth, then a lot of y'all who want to stay in the Marines, a lot of sailors who want to stay in the Navy, same thing for Army, same thing for Air Force, will be told to go home. I don't think that's a good idea. Thank you. First chance all the time. I'd like to know what you have to say about the recent activities of Fallujah. I can't even imagine how it feels to be a Marine who has fought in Fallujah and to watch what's happened, or to be the family of a Marine that we lost in Fallujah. Descent into chaos, the security situations unravels there, has the Marines who fought there, the Marines who were wounded there, the Marines who died there, they fought with great honor, great purpose, great dedication. It is tragic beyond belief that the government of Iraq could not sustain what Marines paid in blood to get. Who's next? Good afternoon, sir. Last but not least, John, hello, Marines. Where am I looking? Over here in the left. OK, sorry. I'm standing in the saloon. We mentioned our political media ourselves about creating our awareness for the average citizen or part of it. Part of that's the job of folks like me. Part of it is, just like you said, the media. Part of it's outreach when we do fleet weeks, when we do marine weeks, when we send things like the Marine ban places. Shows people how good, how professional, how skilled Marines are. I actually think that Marines, that people have a better appreciation of Marines than anybody else. Because when trouble happens, what do people say? Send in the, there you go. I think we just have to, people like me, you when you're home or when you're talking to friends that aren't in the military, explain what you do. Explain the training that you get. Explain what it takes to be a Marine. And keep doing it over and over and over again. Because you provide amazing security, protection, defense for this country. And even though most people aren't aware of it most of the time, they are safe. And they are secure because of what you did. I've got a question about the Blue Joe. Is there any emotion being sent in place to maybe send some forces over there to try to take back what we love? The Secretary of State, John Kerry, announced that there would be no, nobody going in. No American boots on the ground. We are sending equipment into the Iraqis. But that's the extent of it. There was a pretty flat statement that there would be no Americans going in. All right, one more. You can hear the last part of that. You know, one of the things I talked about out of Afghanistan was the need for the Afghans to take the lead in security and the need for us to move into a support role, which has happened. That was one of the reasons I talked about why I thought the Afghan Army, national police, local police were doing a good job in the places I've been. I've been in Afghanistan now a dozen times. And I sincerely hope not, either in Afghanistan or Iraq. But these things move into the hands of the Iraqis or the Afghans, and it's up to them to provide for that security, at least in my trips to Afghanistan and to where I've been, to where the Marines have been operating now for more than a decade. The Afghan Army and the other Afghan units have been stepping up and have been doing a pretty good job in terms of protecting the gains that the Marines and sailors, soldiers, Air Force have gained over the last decade or so. And I deeply, truly hope that those gains will not be lost. All right. Like I said, if anybody wants to stay and take a picture, that would be great. Lance Corporal, I particularly want to see you from Ackerman. But I'll stay here as long as y'all want to take pictures. And again, an answer to the question on behalf of American people, who you make safe, who you give options to their leaders, who you have devoted your talent, your skills, your lives to protecting. Thank you. Semper Fi, Marines.


It's a very good feeling, somewhere I feel young, somewhere I also feel I'm getting old because the 13 number is there and lot to achieve, but yes I definitely appreciate the platform that these guys have created to encourage young talent and to motivate us day in and out to prove better and to deliver things which are above competition and to be there on the top always. Coming from a media agency, yes it is number driven and if you know it goes hand in hand actually so the numbers, the data actually help us, so I come from a content team and the numbers, the statistics and the data always helps us to derive more insights which you know we can leverage into more creative and content ideas on a daily basis so yes I would say it's number driven, but they don't stop you from creating new things or coming out with new content and as you see now the industry is moving towards content and all these numbers, statistics and data definitely helps us to develop new ideas and new content on a daily basis.


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This is Nudge, he's my troop horse. We call him Nudge because he likes to nudge me most days. Not today though. He's a bit camera shy.