2.2.6: Record bottlenecks and enablers
While the 7-1-7 timeliness metrics provide a quantitative measure of the performance of systems for surveillance and early response, on their own they do not provide information about why systems did or did not perform well. Documenting the bottlenecks and enablers of system performance is critical for identifying best practices as well as the specific systems or processes that require strengthening. Bottlenecks and enablers are factors that, respectively, prevent or facilitate timely action.
After recording the timeliness metrics and reviewing whether the 7-1-7 target has been achieved, individuals directly involved in the initial investigation and response should consider holding a participatory session to discuss bottlenecks, enablers and their root causes:
- Review 7-1-7 data to identify bottlenecks and enablers by considering potential reasons that may have hindered or facilitated, respectively, the timeliness of processes in the detection, notification and response intervals. These bottlenecks and enablers may be technical, operational or political.
- When identifying bottlenecks, ensure that they are clear and root causes are determined so these can later be addressed. Examples of clear bottlenecks are provided below. Stakeholders may utilize brainstorming approaches such as “Five Whys,” where “Why?” is simply asked multiple times (more or less than five) in succession until a root cause is determined. Alternative methods that can be used to conduct a root cause analysis are the fishbone diagram, interviews and focus groups.
|Characteristics of a clear bottleneck||Unclear bottleneck||Clear bottlenecks|
||“Lab transportation”||“Lack of dedicated vehicle for lab transport to collect samples from health facilities”
“Lack of fuel for the vehicles at the clinic to transport samples from the health facility to the laboratory”
Global health security is only as strong as the weakest link.
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