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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:

Characteristics of a clear bottleneck Unclear bottleneck Clear bottlenecks
  • Phrased in specific terms
  • Defines the root cause of an observed delay
  • Focuses on systemic issues and avoids individual blame or complaints
“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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