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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

â—ŹInadequate workload balance

â—ŹAdditional skills building needed

â—ŹForecasts do not match consumption

â—ŹInsufficient funds for distribution

â—ŹEnsure availability of vaccines to all children

â—ŹReduce operating costs/improve cost effectiveness

â—ŹEnsure CCE at all (or at least 80% of) HFs

â—ŹOptimize storage space

â—ŹIntegrate with other cold chain products

â—ŹConsider different vaccine vial presentations

â—ŹReach underserved/hard-to-reach areas (equity)

â—ŹReduce time spent in logistics

â—ŹGuarantee distribution from district to HF

â—ŹOptimize district/regional stores and their linked network/transport routes

â—ŹOptimize transport system for district distribution and supervision

Niger

â—ŹInsufficient transport, particularly at sub-national levels

â—ŹSecurity challenges in conflict-prone areas

â—ŹHuman resource (HR) constraints in availability and skills

â—ŹAchieve a more reliable system

â—ŹGuarantee regular delivery of vaccines to the last mile

â—ŹEnsure quality of vaccines in sufficient quantity

â—ŹOptimize use of CCE

â—ŹBase supply chain decisions on actual data

â—ŹIntegrate management system with qualified staff

Madagascar

â—ŹFailure to use the regional administrative level for the iSC

â—ŹUnused regional cold rooms

â—ŹAntiquated facility-level CCE depend on propane tanks

â—ŹInadequate funds and insufficient vehicles to support distribution

â—ŹInsufficient HR for iSC management

â—ŹAd hoc district distribution to HFs

â—ŹEnsure an effective, equitable, and adaptable system

â—ŹProvide reliable data

â—ŹReduce operating costs

â—ŹIncrease immunization coverage

â—ŹReduce expired vaccines

â—ŹPromote sustainability

â—ŹUpgrade CCE

Guinea

â—ŹLack of cold chain at regional level

â—ŹInsufficient cold chain capacity at districts and HFs

â—ŹInsufficient means of transport

â—ŹInsufficient HR capacity for CCE maintenance

â—ŹInadequate budgeting and planning based on inaccurate population estimates

â—ŹEnsure an effective, equitable, and adaptable system

â—ŹProvide reliable data through computerized system

â—ŹIntroduce cost savings

â—ŹPromote sustainability

â—ŹDecentralize to ensure all products are available at HF

â—ŹIntegrate and provide high-quality services

â—ŹEnsure availability of CCE at all levels

â—ŹAllocate qualified and sufficient HR

â—ŹEstablish regional cold chain depots