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Table 2 Country-identified bottlenecks in the current iSC and priorities for the system design approach

From: Designing supply chains to meet the growing need of vaccines: evidence from four countries

Bottlenecks Priority
Sierra Leone
Inadequate workload balance
Additional skills building needed
Forecasts do not match consumption
Insufficient funds for distribution
Ensure availability of vaccines to all children
Reduce operating costs/improve cost effectiveness
Ensure CCE at all (or at least 80% of) HFs
Optimize storage space
Integrate with other cold chain products
Consider different vaccine vial presentations
Reach underserved/hard-to-reach areas (equity)
Reduce time spent in logistics
Guarantee distribution from district to HF
Optimize district/regional stores and their linked network/transport routes
Optimize transport system for district distribution and supervision
Niger
Insufficient transport, particularly at sub-national levels
Security challenges in conflict-prone areas
Human resource (HR) constraints in availability and skills
Achieve a more reliable system
Guarantee regular delivery of vaccines to the last mile
Ensure quality of vaccines in sufficient quantity
Optimize use of CCE
Base supply chain decisions on actual data
Integrate management system with qualified staff
Madagascar
Failure to use the regional administrative level for the iSC
Unused regional cold rooms
Antiquated facility-level CCE depend on propane tanks
Inadequate funds and insufficient vehicles to support distribution
Insufficient HR for iSC management
Ad hoc district distribution to HFs
Ensure an effective, equitable, and adaptable system
Provide reliable data
Reduce operating costs
Increase immunization coverage
Reduce expired vaccines
Promote sustainability
Upgrade CCE
Guinea
Lack of cold chain at regional level
Insufficient cold chain capacity at districts and HFs
Insufficient means of transport
Insufficient HR capacity for CCE maintenance
Inadequate budgeting and planning based on inaccurate population estimates
Ensure an effective, equitable, and adaptable system
Provide reliable data through computerized system
Introduce cost savings
Promote sustainability
Decentralize to ensure all products are available at HF
Integrate and provide high-quality services
Ensure availability of CCE at all levels
Allocate qualified and sufficient HR
Establish regional cold chain depots