Project Title

Capacity Building for Community-Based Long-Term Care Supported by High-Tech Low-Cost Resources 

Project Year

2018   

Project Number

HWG 04 2018A 

Project Session

Session 1   

Project Type

Standard 

Project Status

Project in Implementation   
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Project No.

HWG 04 2018A 

Project Title

Capacity Building for Community-Based Long-Term Care Supported by High-Tech Low-Cost Resources 

Project Status

Project in Implementation 

Publication (if any)

 

Fund Account

APEC Support Fund 

Sub-fund

ASF: Health and Emergency Preparedness 

Project Year

2018 

Project Session

Session 1 

APEC Funding

115,000 

Co-funding Amount

46,500 

Total Project Value

161,500 

Sponsoring Forum

Health Working Group (HWG) 

Topics

Health 

Committee

SOM Steering Committee on Economic and Technical Cooperation (SCE) 

Other Fora Involved

 

Other Non-APEC Stakeholders Involved

 

Proposing Economy(ies)

Mexico 

Co-Sponsoring Economies

Chile; Japan; Peru; Thailand 

Expected Start Date

01/11/2018 

Expected Completion Date

31/12/2019 

Project Proponent Name 1

Luis Migel F Gutierrez Robledo 

Job Title 1

Director General 

Organization 1

National Institute of Geriatric Medicine and Mexican Research Network on Ageing/Ministry of Health 

Postal Address 1

Avenida Contreras 428, Colonia San Jeronimo Lidice Ciudad de Mexico, CP 10200, Mexico 

Telephone 1

52-55 55738686 

Fax 1

Not Applicable 

Email 1

lmgutierrez@inger.gob.mx 

Project Proponent Name 2

Not Applicable 

Job Title 2

Not Applicable 

Organization 2

Not Applicable 

Postal Address 2

Not Applicable 

Telephone 2

Not Applicable 

Fax 2

Not Applicable 

Email 2

Not Applicable 

Declaration

Luis Miguel F Gutierrez Robledo 

Project Summary

Demand for long-term care (LTC) for older people increases in LAMIC economies where formal LTC systems are scarce or inexistent and as a consequence, informal care remains the main source of care provision. Economies need to respond establishing sustainable and equitable LTC systems, presenting opportunities for innovation, and market development. We propose, to design a capacity building Program on Community Based Long-Term Care (CBLTC) that will lead to the development of pilot interventions in participating economies. The project is focused on the benchmarking of available resources and best practices in Japan and Thailand through 4 main activities: 1) identify and prioritize needs and specific areas of focus and collect information for comparison on existing LTC initiatives; 2) assessment of existing training in LTC, aiming to build on past experiences; 3) the preliminary adaptation of training programs and standards of care, 4) the design of a proposal for pilot intervention in Mexico.

Relevance

Relevance – Region: Problem: Demand for long-term care services for older people is increasing rapidly in low- and middle-income economies, where formal public long-term care systems are scarce or inexistent and as a consequence, informal care remains the main source of care provision for older adults. Economies need to establish long-term care systems that are sustainable and equitable. Based on current experiences in high income economies, Community based LTC should be prioritized over institutional based LTC. This is also an opportunity for social and technical innovation, as well as market development. The Governments of Japan and Thailand through a Japan International Cooperation Agency (JICA) collaboration have jointly implemented interventions to deploy volunteers in long-term home care, by training older adults from local communities to make home visits to impoverished and vulnerable older people and to facilitate access to health services and other social services. Despite some evidence of benefits to the physical and mental health of older people and greater uptake of other services from these initiatives, unmet needs are still prevalent, and signs of increasingly unregulated private services are evident. In this context, we find a scope for low- and middle-income economies to develop large-scale networks of community-based long-term care volunteers, complemented by other actions, including training about health in later life and investment in community service development strengthened by social and high tech-low cost innovation initiatives. Other economies in the Asia Pacific Region could also learn and benefit from this experience that is susceptible of adaptation to the cultural context. 

Relevance – Eligibility: This project is aligned with the APEC Sub-Fund on Health and Emergency Preparedness, specifically on Health, focused on aging population, considering no one should be left behind and demographic change opens new opportunities for progress in health policy. This initiative is in accordance with the mandate of the Health Working Group and supports the objectives to strengthen health systems to improve accessibility, sustainability and quality of healthcare, and healthy populations across the life-course. In the same way, this project could contribute to achieve the Healthy Asia Pacific 2020 Roadmap related with invest in the health of our population at all stages and address the health needs of aging populations, through social and technical innovations for working with partners to improve people’s health and well-being, aiming to promote trade, security, inclusive growth and development in the APEC region. 

Relevance – Capacity Building: All APEC member economies could benefit from this project. The capacity building goals, objectives and principles are:

Goals for capacity building:

To promote transformation of social, economic, and environment sectors through multi-sectoral and intersectoral actions.

To improve economic and social well-being of the people through strengthening innovation capacities competitiveness and connectivity, enhancing people to people strategies and institutional connectivity; throughout the development of IT networks to support the operation of the LTC system.

To contribute to the development of long-term care systems in the participating economies.

Objectives for capacity building: This project helps to identify actions for community based long term care interventions. This capacity building will contribute as well to gender equity it would alleviate the burden of care that they experience nowadays thus contributing to reduce economic disparities among APEC economies; and contributing to improve the economic and social well-being of the people.

Operational principles: This proposal is based on a well-identified need related to the aging of the population and the need for care as a related opportunity, taking into account the experience already existing in several APEC economies such as Japan and Thailand, which could be disseminated. The objective of this project is to have a long-term impact and it can also be replicated internally and regionally.

Objectives

The main objective of the project is to develop a pilot intervention on CBLTC designed as part of a benchmarking process of Thailand's Community Based Long-Term Care experience. This pilot intervention would be developed to be implemented  in Mexico in the first place, but the fundamentals could eventually be disseminated to other participating APEC countries with similar economies. In order to do so, the specific objectives are:

1)  To prepare a report on the current situation regarding the capacity of Community Based Long Term Care in Mexico, Chile and Peru.

2)  To review the design, planning, financing and implementation of the Community-Based Long-Term Care system in Japan and Thailand as well as its effectiveness, costs and implementation barriers, analysing of information obtained through remote communication with the people responsible for its operation in Thailand.

3)  To adapt a preliminary set of training programs, standards of care and quality indicators in community-based long-term care that will be part of the pilot intervention through a workshop with relevant stakeholders.

4)  To identify relevant stakeholders from the public and private sectors as well as civil society organizations and establish a working group that will contribute to the development of the pilot intervention throughout the entire process following the “Theory of Change” methodology.

5) To design a Community-Based Long-Term Care pilot intervention which includes the measurement and documentation of their effectiveness, costs, as well as implementation barriers and areas of opportunity.

Alignment

Alignment - APEC:  The project seeks to contribute to the Quality Growth and Human Development (2016 APEC Leader´s Declaration) because healthy aging though better low-cost strategies to attend aging population needs, will allow APEC economies enhancing health and social security systems by reducing expenditure on social security as well as in hospitalization. 

Alignment – Forum: The proposal is in agreement with the priority developing human capital and with HWG Strategic Plan 2016-2020 whose objectives include to promote health in all policies, and a holistic approach namely a whole of government, whole of society and whole of the region approach to improve people’s health and well-being by: Strengthening health systems to improve accessibility, sustainability and quality of healthcare;  Supporting healthy populations across the life-course, Encouraging and facilitating collaboration between health and other sectors such as the social sector and international health bodies as WHO; and encouraging research and supporting innovation that adds value to health systems and meets the needs of all APEC member economies. 

The project is also aligned with the recommendations from the APEC International Workshop on Adaptation to Population Ageing issue held in Ha Noi Vietnam on July 18th, 2017: Develop and implement comprehensive policy frameworks for healthy ageing, and particularly provide human and financial resources and create favourable conditions to care for the elderly and develop and implement comprehensive regulatory frameworks.

TILF/ASF Justification

Not Applicable.

Beneficiaries and Outputs

Outputs:

1) Report review of CBLTC in Chile Peru and Mexico; a conceptual model will be generated on the capacity building for community based long-term care systems through the identification of stakeholders and remote collaboration through the Project Leader. A working group at the National Institute of Geriatrics (INGER) Public Policy Lab in Mexico will lead a documental investigation and review the policies,  available resources and experiences in LTC initiatives in participating economies following the methodology of scoping review, identifying and prioritising needs and specific areas of focus.

2) Workshop in order to develop the fundamentals of the pilot intervention in CBLTC; a workshop with experts from the participating economies, as well as other countries with long-term care policies in place like Australia, New Zeland and Korea. The experts will discuss their national experience and identify, following the methodology of  “Theory of Change” the main steps to follow in order to develop the components for the pilot intervention: a) training program in LTC, b) standards of care and c) quality indicators. Through a continued remote work led by  INGER lab we will share the developments leading to the generation of the deliverables according to the map to be generated by means of the “Theory of Change” methodology, stablishing  specific priorities and needs.

3) Development of two products: a Final report, no longer than 100 pages and a guideline for the  pilot intervention by CBLTC; including the development of the fundamentals of the training program and standards of care as part of the pilot intervention, as well  as identifying needed materials and documentation, developed through collaborative work led from INGER’s Public Policy Lab. 

Outcomes: Among the expected results of the project are then: a Final report on the current situation regarding CBLTC in participating economies; including a review of the CBLTC system in Japan and Thailand;  the description of the development process of the pilot intervention designed for CBLTC with the fundamentals necessary to develop similar interventions in any of the participating economies  and including training program, standards of care and quality indicators needed for measurement and documentation of their effectiveness and costs, and finally the identification of main implementation barriers and areas of opportunity. 

The results of the project will contribute to the development of community-based long-term care systems by providing inputs, including a theory of change based process mapping for the developmentof   interventions that can be implemented, as well as training programs, standards of care, quality indicators, locally validated and internationally comparable by being aligned to the WHO Strategy and Action Plan on Ageing and Health. 

The information derived from the project will serve to create or update labour and technical standards, care models, evaluation programs and quality management systems in community-based long-term care, useful for both the public and private sectors. 

The direct participants of the project will be experts with experience as well as technical and governmental capacity to contribute to the implementation of community based long-term care interventions. In Mexico, the National Institute of Geriatric Medicine form the Ministry of Health; led by his Director General the Public Policy Lab staff and two researchers specialized in Long Term Care Dr. Mariana Lopez Ortega and Dr Eduardo Sosa Tinoco and Dr. Jun Kawabe Saito liaison with Japan International Cooperation Agency (JICA) at Mexico City. From Chile, the Minister of Health has confirmed his commitment through the participation of the Department of Geriatric Medicine at the Catholic University led by Prof. Pedro Paulo Marin and with the participation of Dr Rosita Kornfeld who is also the Independent Expert on the enjoyment of all human rights by older persons at the United Nations. From Peru, Dr José Francisco Parodi Director of the Ageing Research Center at the University San Martin de Porres. From Japan, Prof. Takako Tsutsui has agreed to participate in the project.  Prof. Tsutsui is the expert on Japanese Long-term Care Insurance working at the National Institute of Public Health and knows everything about the program in Japan; her colleague, Dr. Masaaki Otaga has also agreed to participate in the project.  He knows well about LTCI and community based long term care in Japan. From Thailand, Arunee Laiteerapong (Chulalongkorn University, Thailand) and a ministerial representative from the Long Term Care program. 

Besides Dr. Leocadio Rodriguez Mañas Head of the Global Ageing Research Network (GARN) from the International Association of Gerontology and Geriatrics has agreed to participate as an expert .Beneficiaries: The primary beneficiaries of project products may be policy makers, health sector authorities, non-governmental organizations, and personnel working in community-based long-term care that are in position to design, plan, budget, implement and evaluate community based long-term care services in all participating economies. 

Other end users of project products such as ageing and LTC institutions from other similar economies in the APEC region which would be the secondary and long-term beneficiaries.

Dissemination

The final report, the pilot intervention designed, as well as proposals for training programs, standards of care and quality indicators of Community-Based Long-Term Care will be published and disseminated through the websites of APEC and the participating economies and will be sent to relevant key actors that can contribute to the implementation of domestic or local systems of community based long-term care of the APEC region.  They will be disseminated as well through the Global Aging Research Network of the International Association of Gerontology and Geriatrics. 

The products derived from the project will serve as a basis for the implementation of updating and standardizing vocational training and professional practice in the field of community-based long-term care.

The project, assumes in turn the following principles:

Engagement: Commitment and participation of all social actors in the process.

Gender equality: Integrate the gender dimension in research and innovation contents.

Sustainability and social justice/inclusion.

Science Education: Scientific education as a means to promote change.

Open science: Research, data and dissemination of the project will be accessible to all levels of society, but focused on the scientific field. Open science implies (1) Open Access; that is, free online access to the results of research funded by public entities, and (2) Open Data.

Citizen science: Involve society in our project activities. It is not only about involving scientists, clinicians, health care users, providers, policy makers and stakeholders, but also ordinary people, with the aim of encouraging participation in our project at all levels. It is about generating a space to build a scientific culture that is shared by different points of view and by different actors.

Ethics: To increase the relevance and social acceptance of research and innovation results of our project.

Reporting, and other written outputs associated with this project, which will be publically available, will be presented to the Secretariat in a standard of English which requires no further copy-editing. The [Final Report and other project materials], which will be distributed and published as an APEC publication, must be prepared in accordance with the Guidebook on APEC Projects, the APEC Publication Guidelines and the APEC Logo Guidelines. Where contracted labour is used to produce reports or other written outputs, contractor terms of reference must state that all will be presented in a level of English fit for publication and require no further copy-editing by the APEC Secretariat.

Gender

In all stages of the project, both women and men will be asked to participate, as long as they have technical capacity and interest in the creation or improvement of Community-Based Long-Term Care. 

Considering that the majority of the people who currently participate in the formal and informal provision of community-based long-term care in Mexico, Chile and Peru are women, the projects that generate best practices and support models will mainly benefit them. However, in order to respect the principle of gender parity, it will be ensured that there are at least 30% men among the speakers / experts or participants in the project.

Work Plan

1) November - December 2018: Review on the current situation regarding the capacity of Community Based Long Term Care in Mexico through the identification of stakeholders and remote collaboration through the Project Leader. The end product will be the generation of the benchmarking report with a meta-analysis of current initiatives following the scoping review methodology. The working group will be integrated within the public policy lab at INGER. In this first phase of the project, the service contracts that will be required to carry out the  logistics and organization of the workshop, will also be established. 

2) January - February 2019: The working group will lead a documental investigation and review the policies of available resources and experiences in LTC initiatives in Thailand and Japan following, identifying and prioritising needs and specific areas of focus to then conduct remote collaborative communication with responsible persons Thailand's system of community-based long-term care to learn operational details of its implementation. This site has been selected because of the successful CBLTC experience developed on site with the support of the Japanese government. Ties have been already developed with experts from Japan, Chile, Peru and Thailand who are also members of  the World Health Organisation working group on long term care. 

3) March -  April 2019: Establishment of a working group in Mexico to analyse the information collected from both the scoping review and the remote communication with the people responsible for the operation of the CBLTC system of Thailand and prepare preliminary proposal for the design of community-based long-term care pilot intervention, including a proposal for pilot’s funding through social impact bonds. 

4) Workshop in May 2019 in Mexico City, for 3 days led by experts from WHO and the Global Aging Research Network aiming to discuss, identify and prioritize needs and areas of focus, and to set objectives and key indicators to measure the success rate and allow the development of the funding proposal. In the workshop we will establish and conduct working groups conformed by experts and participants to: define the three main preliminary components for the pilot intervention: a) training program in LTC, b) standards of care and c) outcome and quality indicators; and to develop the pilot’s funding proposal through impact bonds. 

5) June 2019 - August 2019: Development of specific fundamentals of the training program and standards of care as part of the pilot intervention, including identifying needed materials and documentation, through collaborative work and share the development of the optimal interventions and deliverables according to the generated conceptual model and Mexico´s specific priorities and needs. 

6) September - November 2019: Development of pilot intervention and deliverables: including report, pilot’s funding proposal and guidelines for the intervention. 

7) January 2020 drafting, endorsement and submission of the Completion Report and all supporting documents to the Secretariat. 

9) 6 to 12 months after project end date: participation in the Long Term Evaluation of APEC Projects conducted by the Secretariat, as required by all APEC funded projects.

Time

Tasks

Deliverables/outputs

Nov - Dec 2018

Review on the current situation regarding the capacity of CBLTC in Mexico, Chile and Peru.

Report reviewing current CBLTC initiatives in Chile Peru and Mexico.

Jan - Feb 2019

Benchmarking including documental investigation and review about current policies and experiences in CBLTC initiatives in Thailand and Japan.

Remote communication with the people responsible for the operation of Thailand's CBLCT system to learn operational details of its implementation.

Report reviewing, using scoping review methodology, the CBLTC system in Japan and Thailand.

Report on implementation of CBLTC system in Thailand.

Mar - Apr 2019

Establish working group between Mexico, Chile and Peru  to prepare preliminary proposal for the design of CBLTC pilot intervention.

List of members and specific tasks of the working group.

May 2019

Conduct a workshop in Mexico City, aiming to discuss, identify and prioritize needs and areas of focus, and to set objectives and key indicators to measure the success rate and discuss main preliminary components for the pilot intervention. Develop specific outcome indicators to support a funding initiative through impact bonds for the pilots.

Summary report of the workshop, list of objectives, process and outcome indicators for the interventions.

Jun 2019

Development of the fundamentals of the training program and standards of care leading to the pilot intervention, including description of tools and documents. Drafting the funding proposal.

First draft of the training program and standards of care in CBLTC.

Sep - Nov 2019

Review of pilot intervention standards and deliverables: including report and guidelines for the CBLTC pilot intervention.

Report and guidelines for the CBLTC pilot intervention.

Risks

The risk monitoring approach will embed the systematic tracking and evaluation of performance of risk-handling actions, as part of the role and function of the project coordinator, the promotor and local leaders. In that way responsibility for managing risk will not become a separate discipline. Essentially, the approach will compare predicted results of planned actions with the results actually achieved to determine the status and the need for any change in risk-handling actions. The table below shows the main problems and the risks that can be anticipated in this project and the ways to mitigate these risks. 

Description of risk

(indicate level of likelihood: Low/Medium/High)

Proposed risk-mitigation measures

Achievement of the challenging project objectives.

Level of Likelihood: Medium.

Potential impact: Project overall objectives or any of the particular objectives might not be reached

This risk will be minimized by continually assessing progress and deciding on potential fallback strategies at specific decision points. The monitoring procedures adopted will enable partners to follow progress in achieving objectives. At each review point, a decision will be made on whether or not the applied approach will guarantee the achievements of the final objectives. If not, the fallback strategies will be applied.

Delay in starting the phases of the project.

Level of Likelihood: Medium.

Potential impact: Delay in the whole process. Risk for several (or overall) project objectives.

Potential reasons for a delay has been analyzed after INGER past experience. The first outcomes will be used to refine the project development in an iterative approach. Anticipated progress versus achieved progress will be controlled by applying corrective measures, if necessary.

Partners are not reacting as expected, lack of communication, or other problems related to the consortium communication.

Level of Likelihood: Medium.

Potential impact: Misunderstandings, resulting from poor communication, can easily cause technical failures, delays, lead to or exacerbate conflict

Promote team building among members and use more interactive ways of communication. E.g. phone, face to face or teleconference when email is not adequate. Gather all points of view and seek the intervention of the project coordinator to resolve the problem.

Conflicts within the participants.

Level of Likelihood: Medium.

Potential impact: Worsen the global performance, Increase administrative burden if any member has to be replaced; Serious risk for project achievements

Anticipate these possible troubles and develop and implement detailed provisions concerning conflict resolution procedures.

Problems in the management of the project.

Level of Likelihood: Medium.

Potential impact: Delays, time-consuming and potentially costly problems.

A close follow up of project activities will be carried out. Periodic review meetings and reports will be scheduled.

Problems in the dissemination of results. Level of Likelihood: Low.

Potential impact: The desired awareness of the project’s work may not be achieved. Target groups/audiences are not properly reached.

The dissemination activities will be planned from the start of the project. Periodic reviews will be scheduled

Monitoring and Evaluation

The monitoring of the progress of the project will be carried out through the request and delivery of bimonthly partial reports including statement of the fulfilment of the specific outcomes to be defined as the working groups are stablished to assure the deliverables and programmed activities of the project. 

Among the reports that will be delivered are: current situation of long-term care based on the community in Mexico; information on the design, planning and implementation of community-based long-term care systems in Thailand and Japan; analysis and preliminary proposals for the development of pilot intervention; information on activities and results about the workshop; and final report on the design of community-based long-term care interventions. 

The reports will be requested, elaborated, delivered and published through electronic means of communication. 

The proportion of women and men participating in the project activities will be documented. 

The progress indicators of the project works will be included as a percentage of progress in the bimonthly partial reports according to the schedules of activities that are established. Among the specific indicators contemplated are number of CBLTC initiatives to be reviewed, female/male participation rates and number of standards of care. 

The pilot’s funding proposal through social impact bonds will be completed.

Linkages

At the local level in Mexico we are promoting the involvement of the Japan International Cooperation Agency (JICA), through the involvement of Dr Jun Kawabe Saito as an observer in this first stage in order to explore the feasibility of supporting an initiative to disseminate our findings and products at the regional level.

This project builds on a previous successful initiative of community long term care intervention in Thailand, supported by Japan through JICA.

Sustainability

After the project has been completed, the next stage will be the implementation of training programs, standards of care and quality indicators in community-based long-term care, to improve interventions in this area and to propose a domestic program that It is feasible to implement progressively in Mexico in the first place, and eventually other economies in Latin America. In Mexico this stage is part of the initiatives that the Ministry of Health will promote through the General Health Council with the support of the National Institute of Geriatrics and other organizations committed to the development of a nationwide long term care system. 

Funding to develop the pilot interventions is crucial. Throughout the process we will develop a funding initiative based on the Social impact bonds methodology (SIB’s) (http://www.oecd.org/cfe/leed/UnderstandingSIBsLux-WorkingPaper.pdf) For this purpose, a rigorous methodological design for identifying measurable social outcomes and appropriate target groups is of utmost importance. Ensuring continuity of social service delivery by the public sector is indispensable for vulnerable groups and citizens. Therefore, SIBs would be complementary and not the core mechanism for social services delivery. 

The progressive achievement of the planned results and impact will be monitored through the periodic measurement of specifically designed indicators on community-based long-term care as well as with the data obtained in population surveys that collect related information.

Project Overseers

Luis Miguel Francisco Gutiérrez-Robledo, Mexican public official and scholar trained in geriatric medicine and the biology of aging; he received his Ph.D. in Public Health from the University of Bordeaux. He is currently the general director of the National Institute of Geriatrics appointed in January 2018 for a 5 year period at the National Institutes of Health of the Ministry of Health of Mexico. He has served in various national and global committees including the Advisory Committee at the International Association of Gerontology and Geriatrics, and the Pan American Health Organization; he is a founder member of the Latin American Academy for the Medicine of Ageing (ALMA); he has been an advisor to the World Health Organization on issues related to aging and has participated in the expert group that developed the global strategy and action plan on ageing and health in 2016.

Administrative support will be provided by the Institute’s research administration unit in Mexico City.

Cost Efficiency

Not Applicable.

Drawdown Timetable

Not Applicable.

Direct Labour

Not Applicable.

Waivers

Not Applicable.

Are there any supporting document attached?

No 
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Project No.

Project Title

Project Status

Publication (if any)

Fund Account

Sub-fund

Project Year

Project Session

APEC Funding

Co-funding Amount

Total Project Value

Sponsoring Forum

Topics

Committee

Other Fora Involved

Other Non-APEC Stakeholders Involved

Proposing Economy(ies)

Co-Sponsoring Economies

Expected Start Date

Expected Completion Date

Project Proponent Name 1

Job Title 1

Organization 1

Postal Address 1

Telephone 1

Fax 1

Email 1

Project Proponent Name 2

Job Title 2

Organization 2

Postal Address 2

Telephone 2

Fax 2

Email 2

Declaration

Project Summary

Relevance

Objectives

Alignment

TILF/ASF Justification

Beneficiaries and Outputs

Dissemination

Gender

Work Plan

Risks

Monitoring and Evaluation

Linkages

Sustainability

Project Overseers

Cost Efficiency

Drawdown Timetable

Direct Labour

Waivers

Are there any supporting document attached?

hdFldAdmin

Project Number

Previous Fora

Secretariat Comments

Reprogramming Notes

Consolidated QAF

Endorsement By Fora

PD Sign Off

Batch

Forum Priority

Committee Ranking Category

Committee Priority

PDM Priority

Priority Within Funding Category

Monitoring Report Received

Completion Report Received

PMU Field 1

PMU Field 2

PMU Field 3

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