1. McKinsey & Company 1
Problem statement worksheet
How can Nigeria’s Ministry of Health (MOH) increase adequate availability of usable vaccines for routine immunizations from currently 30-
45% of local primary healthcare facilities to over 90% within 2 years?
Basic question to be resolved
 Vaccines are among the most cost-effective health interventions and are a key lever
to reduce under-5-mortality, which accounts for more than 90% of mortality among
children under 18
 The performance of the immunization program in Nigeria is significantly below global
average
 ~2.5 million children in Nigeria are not vaccinated
 The national headquarters usually begins the year with an adequate supply of
vaccines
1 Perspective/context
 Leading indicator: % of local primary healthcare facilities with
adequate stock levels > 90%
 Lagging indicator: total number of vaccinations
 Increased level of coordination between MOH and development
partners
2 Criteria for success
 Any interventions that aim to improve the supply chain and logistics are in scope
 Increases in the overall budget for the procurement of vaccines is outside of the scope
 Changes in the types of immunizations provided are outside of the scope
3 Scope of Solution Space
 The total budget for supply chain and logistics must not increase
 Solution must include some quick wins that demonstrate impact
within first 3 months
 Impact must be realized within 2 years
4 Constraints within solution space
▪ MOH (Nigeria’s Ministry of Health)
▪ Leadership: Executive Director Dr. Adebayo, Head of Immunization
Dr. Oni, Head of Finance Mr. Okafor, Head of Procurement Dr.
Mohammed, Head of Statistics Dr. Chukwu
▪ Frontline workers in supply chain and at local facilities
▪ Development partners, e.g. Immunization Today! (e.g. in-kind
donations), the Light Foundation (e.g. donation of funds), and the
International Health Alliance (e.g. technical assistance)
5 Stakeholders
 MOH top officials
 Workers at the state and local government area (LGA) level
 Data from MOH Department for Statistics
 Local consultancy also engaged by client (did previous research)
 Development partner reports
 McKinsey Social Sector Practice
 McKinsey Operations Practice
 McKinsey Vaccines Expert
6 Key sources of Insight
SOLUTION

2. McKinsey & Company 2
Break down the problem
20 minutes
As a team, go to the Hub and download the break down the problem
issue tree activity
 Apply the MECE principle to see how it can be improved (We are
looking for error correction / “minor” improvements only)
 Capture what you would change on the PPT
 Remember to save your work
Hint: Look to see if all the branches are there, if they are at the
same level, and if all the components are at the same level.

3. McKinsey & Company 3
Issue Tree – Branch 1
How can the
MOH ensure
sufficient
equipment at
HQ?
How can the
MOH ensure
sufficient
vaccines at HQ?
How can MOH increase
quantity of vaccines at HQ?
How can MOH improve the
timing of purchasing at HQ?
How can MOH adjust the type
of vaccines purchased at HQ?
How can MOH ensure
availability of cooling
equipment at HQ?
How can MOH ensure
availability of tracking
materials at HQ?
Secure sufficient quantity
of tracking materials
Ensure maintenance
of cooling equipment
Select the most appropriate
types of cooling equipment
Use QR codes to track
materials
Purchase sufficient quantity
of cooling equipment
Reduce loss of vaccines at
head-quarters (e.g. spoilage,
theft)
Acquire more vaccines
How can the
MOH ensure
sufficient inputs
at the national
headquarters
(HQ)?

4. McKinsey & Company 4
Issue Tree – Branch 2
How can MOH reduce
other sources of losses
during transport?
How can MOH reduce
theft during transport?
How can MOH reduce
spoilage during
transport?
How can MOH decrease
spoilage caused by
heat?
How can MOH minimize
breaking of ampoules?
How can MOH reduce
internal theft?
How can MOH
reduce external theft?
Install padlocks on
delivery trucks
Incentivize honesty
Make theft more difficult
Create safe zones along
the delivery routes
Optimize delivery routes
for smoother roads
Increase the cushioning
of ampoules during
transport
Acquire ampoules
less sensitive to heat
Improve coolers
used in transport
Purchase refrigerated
trucks
How can the MOH
minimize losses as
they are
transported to
local primary
health facilities?

5. McKinsey & Company 5
Issue Tree – Branch 3
How can the local
facilities re-order vaccines
effectively?
How can the local
facilities distribute supply
more effectively?
How can the local
facilities receive and store
vaccines more
effectively?
Order the right amount at the right time
How can the local facilities
monitor supply and
demand more effectively?
Eliminate administrative delays in payments and
processing
Ensure workers track distribution
Ensure workers are able to access supply
Keep them safe
Keep them cool
Keep them organized
Make them accessible
Ensure workers are able to administer vaccines
Ensure community is receptive to vaccines
Invest in tracking technology
Optimize monitoring processes
How can the MOH
ensure adequate
management at
the local primary
health facilities?