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Dr. Rhoda Wanyenze explains how researchers can work more effectively with policymakers

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In advance of the World Health Summit Regional Meeting, we spoke with the Dean of Makerere University School of Public Health about how researchers and academics build trust and gain influence with decision makers

Ahead of this year’s World Health Summit Regional Meeting, we spoke with Dr. Rhoda Wanyenze, the Dean of Makerere University School of Public Health, about the theme of this year’s event – bridging the science-to-policy gap for global health.

Dr. Rhoda Wanyenze, who has collaborated with government health officials to develop evidence-based policies from HIV to COVID-19 and maternal and child health, said that researchers and policymakers can, among other things, “interpret the data together, make sure the interpretation is appropriate, and tease out the actions they’re going to take.”

Dr. Wanyenze, who is also a principal investigator for Exemplars in Global Health’s COVID-19 research, added: “Let the primary focus not just be the publication [of the research], but also, responding to [policymakers] needs and giving them information that they can use.”

Across sub-Saharan Africa, research institutions have been partnering with policymakers to help inform policy decisions for decades. For example, the Infectious Diseases Research Institute in Uganda and the Uganda Virus Research Institute supported the Ministry of Health through the COVID-19 pandemic and recent Ebola outbreak. In fact, during the 2022 Ebola epidemic, the Uganda Virus Research Institute repurposed some of its research laboratories to support the government’s disease response and diagnostics efforts.

Many of the continent’s universities, including the School of Public Health at the University of Kinshasa, the Muhimbili University of Health and Allied Sciences in Tanzania, the Cheikh Anta Diop University of Dakar, and the University of Zimbabwe, also have strong collaborative relationship with health officials. The University of Zimbabwe, for example, embeds some of its students within the country’s Ministry of Health.

The Makerere University School of Public Health has a similar track record of partnering with and helping inform policymakers in Uganda. To explore how researchers and academics can establish mutually beneficial relationships with policymakers ahead of the World Health Summit Regional Meeting on April 13 in Washington, D.C., Dr. Wanyenze offered her thoughts in an interview

Researchers often struggle to identify the best moment to reach out to policymakers. What does your experience tell you?

Dr. Wanyenze: You don’t wait until you’ve conceptualized the questions, then go to them when you are at the tail-end or when you are presenting the findings. After you present, they’ll ask, Did you also do this?’ And you’ll say, “No, I didn’t.’ And then they’ll ask, ‘Did you also do that?’ And you’ll say, ‘No, I didn’t do that either.’
Sometimes I find that we make a lot of assumptions about what they need to know. Before we even begin to craft our research questions, we need to understand what they’re struggling with and ensure that we are aligned to their needs as we gather evidence.

I’ll give you an example: several years ago, we were beginning to work out how we can move from traditional HIV testing methods to self-testing. We were working on designing a randomized controlled trial to test the effect of this. We had to speak with the Ministry of Health to understand: what is it that they worry about? What is it that would make them not want to adopt this policy?

We also didn’t have just the [Ugandan] Ministry of Health, we had other stakeholders, including people living with HIV, women living with HIV, and we could hear their voices loudly. ‘People will fight. We shall have divorces. We shall have violence.’ We had to think through carefully, if we are going to do this trial, we have to have sufficient mechanisms to deal with potential risks.

At the same time, we must collect this information in a bit more detail so that at the end of the day, we are not just saying, ‘This trial works,’ but we are saying, ‘It won’t cause harm, or if it causes harm, this is how you can mitigate it.’ We had to carefully do this trial with sufficient safety nets to respond to these issues. We had to think about the referral resources, for example, should we have any violence.

Then they told us, ‘We want to know the cost.’ Initially, we had not planned to include costing, but we had to integrate something that can support them to be able to make that decision.

Another example is research my team did on the impact of COVID on maintaining essential health services in Uganda. We presented to the Ministry of Health and its partners our proposed objectives and selected disease indicators to track in the maintenance of essential health services. They informed us that other partners were already working on some of the indicators such as HIV, TB, and maternal health. Rather than duplicate these indicators, they advised us to focus on other indicators which had not been addressed. We agreed to reorient the focus with the resources we had, to harmonize our work with other partners and ensure responsiveness to the needs of the Ministry of Health. Later, when the EHS continuity committee published updated guidelines on maintaining essential health services, it included recommendations based on our research.

How do you manage policymakers’ shifting needs and incorporate their feedback throughout the lifetime of your research?

Dr. Wanyenze: Interim feedback loops are critical to being sensitive to their needs. The challenge is you might not be funded to do everything they ask you to do, but sometimes you find things that are easy to integrate without necessarily spending much. It might involve a few more questions that you can address, with the resources that you have, and produce additional evidence that is needed by the ministry. The benefits are tremendous. By engaging them, they develop a sense of ownership. So that they feel, ‘This is our research.’ And they actually begin to say, ‘When are you giving us the results?’

How should researchers think about reporting out their results to policymakers?


Dr. Wanyenze: Working with policymakers through interpreting the implications of your work is really important. It can help when planning how to disseminate the work so that it is more meaningful.

For one project funded by the Global Fund – a partnership to enhance analytical capacity and data use in Eastern and Southern Africa called PERSuADE – we prioritized the areas for analysis with the Ministry of Health and then we worked with their teams and generated the evidence they needed. Then we were able to track what actions they’ve taken based on the findings.

If you work with the Ministry of Health and any other partners and you use their data or involve them in the data collection, analysis and interpretation, make sure that you include them as co-authors. A common challenge we have experienced is researchers who work with the ministries and other stakeholders publishing the findings without including them as authors or even informing them and sharing the findings.

How do things change if you are working with routine data the government collects?

Dr. Wanyenze: If you are working with data that the government routinely collects, you need to be engaged with policymakers in terms of how you’re going to use that data and that you are actually going to add value and do a good quality analysis that will help them answer their questions. Also, you need to be clear that you will not use their data for anything else without their permission. Sometimes researchers will get this data and they’re flying off and doing other things than what was originally agreed upon. And before you know it, they’ve published it without the government knowing. You need to ensure trust and a partnership that’s respectful.

What advice do you have for research organizations that currently do not have a relationship with the government but want to develop one. How can they establish a mutually beneficial and respectful relationship?

Dr. Wanyenze: Whether you want to work with a ministry of health or an NGO, the process is the same. You need to engage with them to clarify the partnership and expectations. There has to be benefit to the ministry or the NGO to want to work with you. The benefit often will be that you’re generating evidence that will add value to their decisions in a timely manner. You need to be responsive to their needs, to the extent possible.

How can researchers balance the need for quality research, which takes time, and the needs of policymakers, who often have pressing and time-sensitive needs.

Dr. Wanyenze: Timeliness is very important, but it should not compromise quality of the research. Sometimes the research takes long, and researchers will share their findings with policymakers when the findings have been overtaken by events and are no longer relevant. We sometimes prioritize some of their most critical questions and share preliminary findings as we finalize analyses for the rest of the study objectives and papers. Holding back the dissemination until the papers are written is a missed opportunity—we lose the opportunity for feedback from stakeholders to enhance the interpretation of the findings and to use the findings.

by Exemplars News — Originally published by exemplars.health

See original article here

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Mak Researchers Partner with Safe Bangle Technologies to Roll out a Real-Time Domestic Violence Reporting Bracelet

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A Woman putting on the Real-Time Domestic Violence Reporting Bracelet. Makerere University School of Public Health/Resilient Africa Network (MakSPH/RAN), Medical College of Wisconsin (MCW), Somero Uganda, Safe Bangle Technologies roll out of a real-time domestic violence reporting bracelet. Kampala Uganda, East Africa.

By Joseph Odoi

A Consortium of Researchers from Makerere University School of Public Health/Resilient Africa Network (MakSPH/RAN), Medical College of Wisconsin (MCW), Somero Uganda together with Safe Bangle Technologies have rolled out a real time domestic violence reporting bracelet.

    This roll out was made possible with support from the United States Agency for International Development (USAID) under the PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER) program and the National Academies of Sciences.

    Dr. Juliet Kiguli, the Principal Investigator from Makerere University, along with Dr. Roy Mayega, Deputy Chief of Party at RAN, and Dr. Agnes Nyabigambo, the study coordinator, initiated the PEER program to identify entry points for testing SafeBangle Technologies (a social enterprise based at Resilient Africa Network (RAN) with a mission to create a safer and more secure environment for women and children through innovative, affordable, and creative technology solutions to curb GBV in Africa.) wearable safety bracelet in the informal settlements. This decision stemmed from findings of increased intimate partner violence (IPV) and gender-based violence (GBV) in three informal settlements in Kampala, Uganda, following a longitudinal study, geospatial mapping, and interviews. The project, titled ‘The Impact of the COVID-19 Pandemic on Gender-Based Violence among Women and Girls in Informal Settlements in Kampala,’ highlighted the urgent need for affordable and immediate reporting mechanisms for violence.”

    ‘’While carrying out a study after the Covid-19 Pandemic, we identified gaps when it comes to reporting and response to Gender Based Violence (GBV) among women in informal settlements. Therefore, we used incorporated the SafeBangle intervention to solve the problem of lack of affordable and immediate reporting mechanisms for violence using a bracelet that reports violence in real time’’ explained Dr. Kiguli.

    Innovation details

    According to Saul Kabali and Messach Luminsa, the innovators behind SafeBangle from SafeBangle Technologies, hosted at the Resilient African Network Lab. ‘’The inspiration behind SafeBangle came from a deeply personal place. ‘’We heard countless stories of women who couldn’t call for help during moments of danger. We were deeply affected by the story of Aisha, a young woman in a rural village who was attacked while walking home alone at night. With no way to call for help, she felt helpless and vulnerable. This incident made us realize the critical need for immediate reporting alert tools, accessible to women like Aisha. We knew technology could play a crucial role and this incident awakened a strong desire in us to create a solution’’

    Saul Kabali, Executive Director and Chief Operations Lead at SafeBangle Technologies explaining how the bracelet works at 2023 Imara Girls Festival exhibition. Makerere University School of Public Health/Resilient Africa Network (MakSPH/RAN), Medical College of Wisconsin (MCW), Somero Uganda, Safe Bangle Technologies roll out of a real-time domestic violence reporting bracelet. Kampala Uganda, East Africa.
    Saul Kabali, Executive Director and Chief Operations Lead at SafeBangle Technologies explaining how the bracelet works at 2023 Imara Girls Festival exhibition.

    “While developing SafeBangle, we tested with the users in both rural and urban contexts. We piloted the innovation around Kampala with support from Digital Human Righs Lab and Naguru Youth Health Network as well as it in five districts of Karamoja region with support from Save the Children and Response Innovation Lab. Right now it has become handy in Kamapala‘s informal settlements. We envision a future where SafeBangle becomes a standard tool in the fight against GBV, ensuring every woman feels safe and secure as it has the potential to transform how we respond to GBV in Africa” added Kabali.

    HOW THE SAFEBANGLE TECHNOLOGY WORKS

    The SafeBangle is wearable technology similar to a smartwatch that sends an alarm by SMS to people chosen by a woman herself if she feels threatened.

    How the SafeBangle Real-time Domestic Violence Reporting Bracelet works.  Makerere University School of Public Health/Resilient Africa Network (MakSPH/RAN), Medical College of Wisconsin (MCW), Somero Uganda, Safe Bangle Technologies roll out of a real-time domestic violence reporting bracelet. Kampala Uganda, East Africa.
    How the SafeBangle Real-time Domestic Violence Reporting Bracelet works.

    In terms of the acceptability of the SafeBangle innovation as a solution to GBV among at-risk women in informal settlements Of the 72 adolescent girls and women who received the SafeBangle, 22 activated the reporting button, resulting in 19 receiving immediate and appropriate support, including counseling, police intervention, and health services.

    All adolescent girls and women who experienced GBV received a phone call from Somero Uganda to discuss the most appropriate intervention, including counseling, police cases being handled by the probation office, referral for health services, and post-exposure prophylaxis. All the GBV survivors received support and are still receiving continuous follow-up.

    Researchers conducted a survey among 644 girls and women in Kinawataka (Nakawa Division) and Bwaise (Kawempe Division) to gain insights into awareness and understanding of sexual and gender-based violence among adolescent girls and women in informal settlements. The survey measured socioeconomic factors, mental health symptoms, and exposure to GBV. Focus group interviews were conducted with a separate sample of women over 18 in the settlements to explore responses to GBV.

    Preliminary impact of SafeBangle on tracked survivors.  Makerere University School of Public Health/Resilient Africa Network (MakSPH/RAN), Medical College of Wisconsin (MCW), Somero Uganda, Safe Bangle Technologies roll out of a real-time domestic violence reporting bracelet. Kampala Uganda, East Africa.
    Preliminary impact of SafeBangle on tracked survivors.

    A tabular representation of the key findings and lessons learned from your study on gender-based violence (GBV)

    Key FindingsLessons learned
    Prevalence of GBV.
    – Overall prevalence: 34.1% of women and girls reported experiencing GBV.
    – Among adolescents (15-19 years): Over 50% reported experiencing GBV.
    – The pandemic highlighted the need for accessible and comprehensive support services for GBV survivors.
    – Schools emerged as crucial safe spaces for girls, emphasizing their well-being during crises.
    – Economic independence proved crucial, enabling women to leave abusive environments.
    – Involving men and boys as allies in GBV prevention efforts is essential.
    Age-related trends– GBV prevalence tends to decrease with increasing age.
    Physical and health consequences.– Women and girls suffered physical violence, injuries, and deaths, primarily from domestic violence and unsafe abortions due to limited healthcare access.
    – GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS.
    Social and economic impact. .– GBV contributed to family breakups, strained marriages due to financial stress.
    – Economic hardships forced some women and girls into transactional sex, exposing them to further health risks and exploitation.
    – Pandemic-related job losses and economic constraints increased financial dependence on abusers, trapping women in violent situations.
    – School closures and increased household responsibilities limited women’s job opportunities and subjected them to sexual harassment.
    Psychological effects– Survivors experienced guilt, shame, anxiety, fear, and suicidal thoughts due to ongoing abuse.
    Long-term effects– Post-COVID-19, survivors faced disrupted education, early marriages, pregnancies, social stigma, and persistent mental health issues.
    A tabular representation of the key findings and lessons learned from your study on gender-based violence (GBV)

    Reproductive Health Consequences: GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS.

    Family Breakdown: The rise in GBV led to family breakups as women fled abusive relationships. Marriages were strained due to increased financial stress.

    Transactional Sex for Survival: Desperate for basic needs due to job losses and economic hardship, some women and girls resorted to transactional sex, exposing them to further health risks and exploitation.

    One study participant stated, “The time of COVID-19 was so terrible for some of us. We in fact got a lot of diseases from it because you would want to get food and didn’t have money. That way you would be forced to get a man who would use you and pay.” – (FGD_Girls_19–24years_Kinawataka).

    Economic Effects: COVID-19 restrictions caused job losses and limited economic opportunities, particularly for women in the informal sector. This increased financial dependence on abusers and trapped women in violent situations.

    Limited Access to Employment: School closures and increased household chores limited women’s ability to seek employment, perpetuating gender inequality in the workforce. Some faced sexual harassment from potential employers.

    Psychological Effects: Survivors of GBV experienced guilt, shame, anxiety, fear, and even suicidal thoughts due to the constant threat and unpredictability of abuse.

    Post-COVID Effects: GBV survivors faced long-term consequences, including disrupted education, early marriage, early pregnancy, social stigma, and persistent mental health issues.

    Lessons learned

    The pandemic highlighted the need for accessible and comprehensive support services for survivors of GBV, the significance of schools as safe spaces for girls, and the need to prioritize their well-being during crises. Economic empowerment emerged as a significant protective factor for women and girls. Those with greater economic independence were better equipped to leave abusive environments and secure their safety and well-being, while dependent ones suffered abuses. Engaging men and boys as allies in the fight against GBV and involving them in prevention efforts can help promote positive behavior change and foster more equitable relationships.

    Recommendations

    To address GBV against women and girls, the researchers recommend the following moving forward;

    1. There is need to integrate technology-driven solutions like SafeBangle into national GBV prevention and response strategies. SafeBangle can be a valuable tool for policymakers as cases of violence that would have gone unreported will be brought to light and the would-be victims will be able to get immediate help from trusted relatives and friends.
    2. Provide economic opportunities and vocational training for women and girls to enhance their financial independence and reduce vulnerability to violence. There is therefore a need to introduce education and training programs that empower women and girls, by providing them with skills, resources, and opportunities to start their own ventures and to participate fully in community affairs.
    3. Strengthen and enforce existing laws and policies related to GBV, including laws against domestic violence, child marriage, and sexual assault without discrimination be it for law enforcers, leaders, and employers where such cases were suffocated. Ensure that perpetrators are held accountable through swift and fair legal processes that have no room for corruption.
    4. Establish and promote effective, accessible, and confidential reporting mechanisms for GBV incidents that provide confidence and can be trusted by survivors to enhance reporting of such incidences of GBV. Community Engagement and Involvement: Involve community leaders, religious leaders, and elders in discussions about GBV to promote gender equality, change social norms, and reinforce the message that violence against women and girls is unacceptable.
    5. Launch extensive public awareness campaigns to challenge harmful gender norms, report cases of GBV, raise awareness about the consequences of GBV, and promote positive behaviors and attitudes towards women and girls.
    6. Implement comprehensive sexuality education in schools and communities, educating young people about healthy relationships, consent, and reproductive rights to be able to make informed decisions about their own lives and well-being.
    7. Engage men and boys as allies in the fight against GBV, encouraging them to challenge harmful masculinity norms and behaviors. This will help minimize GBV because mostly they are the perpetrators. Strengthening Support for Survivors: Provide ongoing support and follow-up services for survivors of GBV mostly counselling services to aid their recovery and facilitate their reintegration into society.
    8. Provide ongoing support and follow-up services for survivors of GBV, mostly counseling services to aid their recovery and facilitate their reintegration into society.
    9. Provide avenues to seek free or subsidized services by survivors of GBV medical services and legal processes by survivors of GBV to enhance reporting of GBV cases, access to medical care, counseling, legal support, and other essential services.
    10. Encourage and support more research and innovations like SafeBangle to curb incidents of GBV.
    11. A comprehensive and inclusive approach is required. The efforts should involve government institutions, civil society organizations, community leaders, and individuals working together to address the root causes and provide support to survivors.
    12. Involve media in GBV prevention activities and for enhancing campaigns against GBV mostly on radio and TV.

    MORE ABOUT THE STUDY

    The core project team, included researchers at Makerere University School of Public Health (MakSPH), Medical College of Wisconsin (MCW) led by Prof.  Julia Dickson-Gomez, SafeBangle Technologies, and Somero Uganda, a community-focused NGO, began the project by designing their research protocol and taking a CITI Program course on human subjects social/behavioral research. Team members also met with the Ministry of Gender, Labour, and Social Development (MGLSG) in support of the gender-based violence policy process, Ministry of Health and local government. They also established relationships with the Kampala Capital City Authority (KCCA) and Nakawa and Kawempe probation offices to support legal processes for the GBV survivors. SafeBangle Team also received an award from Defenders Protection Initiative.

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    Digital Mobile Technologies to Study Tuberculosis: A Multi-Discplinary Program

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    An aerial view of the Makerere University School of Public Health construction site on the Main Campus. To the Right is the Infectious Diseases Institute (IDI) and in the background are Dag Hammaskjold Hall (Green roof) and University Hall (Brown tiles).

    A TRAINING PROGRAM SPONSORED BY FOGARTY INTERNATIONAL CENTER NATIONAL INSTITUTES OF HEALTH, USA

    INFORMATIONAL SESSION

    Makerere University School of Public Health under D43 multi-disciplinary training program in digital mobile technologies to study tuberculosis that was recently funded by the NIH, through the University of Georgia (UGA) has an opportunity for funding of a masters’ research thesis. This is available to two (02) first year students of the Graduate programmes offered at Makerere University who have progressed to concept proposal development stage of their graduate program. These should be in good academic standing and have or are about to complete year 1 in Academic Year 2023/24. The support will start at the beginning of Academic Year 2024/25, i.e., end of August 2024 when the students are starting their year 2.  Students of geography and or digital health related courses are encouraged to apply, females too.  Students will be provided with secondary data to address the following, or similar, issues relating to tuberculosis (TB):

    1. Characterizing mobility patterns between urban and rural areas of Uganda using archived cell-phone (CDR) metadata
    2. Correlation between self-reported geolocated mobility patterns of TB patients and CDR data
    3. Differences in mobility patterns of TB patient’s pre-diagnosis and post-diagnosis
    4. Gender differences and relationship between IGRA and TST in a prospective cohort
    5. Patterns of change in serial IGRA test results by sex, age, HIV status
    6. Temporal changes in contact, mobility and geographic networks in TB converters and non-converters
    7. Ecological Momentary Assessment (EMA) of social contacts and location patterns of movement by residents at risk for TB infection

    Interested students are encouraged to attend an information session on Wednesday 17th July 2024 at MakSPH Annex Kololo where details about the research questions and funding opportunity will be provided to prospective applicants. Prospective applicants will be required to work with their mentors and training grant personnel to develop a 2-5-page concept that will be vetted for possible funding by training faculty of the training program.

    Interested students should register their attendance with the training Coordinator, Mr Ivan Mutyaba by sending an email expressing interest in attending the session to imutyaba@musph.ac.ug by close of business on Thursday, 11th July 2024.

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    METS Newsletter June 2024

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    Makerere University School of Public Health (MakSPH) Dean, Prof Rhoda Wanyenze (Left), MoH Director General, Dr. Henry Mwebesa (Right) and other stakeholders join Dr. Amy Boore (2nd Right) to cut cake at her farewell event. Golden Tulip Hotel, Kampala Uganda, East Africa.

    The Monitoring and Evaluation Technical Support (METS) Program is a 5-year CDC-supported collaboration of Makerere University School of Public Health (MakSPH), the University of California San Francisco (UCSF) and Health Information Systems Program (HISP Uganda).

    Highlights of the METS June 2024 Newsletter

    • Tracking Trends in HIV Outcomes: The Implementation of HIV Case-Based Surveillance
      • METS in partnership with the Ministry of Health (MoH) and various implementing partners, is spearheading the HIV Case-Based Surveillance (CBS) initiative across Uganda. By February 2024, CBS had been activated in 504 health facilities, with 349 sites (69%) actively transmitting data.
      • Trends of New HIV Diagnosis: An analysis trends over a 20-year period (2000-2022) revealed an increase in new HIV diagnosis over time, peaking in 2014 and 2018, before starting to decline. Diagnoses among females consistently exceeded those among males each year.
      • Case-Based Surveillance (CBS) complimenting other HIV surveillance programs: CBS provides valuable insights into infection patterns and highlights the need for targeted interventions, particularly among females. Next steps include continued scale up of CBS implementation to reach 80% of ART sites; improving data transmission from facility to the national repository to achieve at least 90% of the CBS activated sites; and strengthening data analytics and use of the data for program improvement.
    • Enhancing HIV Prevention Data Collection Through Bootcamps
      • METS in collaboration with HISP Uganda held a workshop in Mbarara to update the Health Management Information System (HMIS) tools for PrEP (Pre-Exposure Prophylaxis) in the HIV Prevention Tracker. The workshop focused on digitizing paper forms to efficiently collect data on key and priority populations.
    • Electronic Medical Records (EMR) upgrades in Eastern Uganda
      • The two-week activity kicked off with a week-long training session at Northeast Villa in Kumi focused on the enhancements of UgandaEMR+, including improved point-of-care (POC) functionalities and data visualization techniques.
      • The initiative successfully trained over 15 AIDS Information Centre (AIC) staff members, including M&E leads, IT personnel, data officers, and M&E managers, in the practical use of UgandaEMR+. Additionally, the two facilities, Ochero HCIII and Kapelebyong HCIV, were upgraded and their staff trained on the new system.
    • Tribute to Dr. Joshua Musinguzi (9/09/1963 – 7/06/2024)
      • Dr. Joshua Musinguzi’s efforts to minimize HIV incidence and death strategically focused on translating knowledge into policies and actions, which has helped Uganda manage the HIV epidemic.
    • Gallery
      • Bidding farewell to Dr. Amy Boore, Program Director, Division of Global Health Protection – CDC
      • Analysing the UgandaEMR Clinical Laboratory Module
      • UgandaEMR+ training for USAID SITES
      • Training for clinicians at Ruharo Mission Hospital on SARI and ILI
      • HIV Treatment Services (HTS) Implementers Meeting

    View on METS

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