 How often have your interventions been slowed down because of a challenge or bottleneck you didn't consider? A bottleneck is a point where there is congestion or constraint in a system, and bottleneck analysis provides a systematic way to diagnose reasons for poor performance and identify actionable solutions. The DHIS2 bottleneck analysis app, or BNA app, simplifies the analysis, visualization and synthesis of routine information using DHIS2. The BNA app supports analysis at multiple levels of the system, with focus on district and subnational levels to identify potential health system bottlenecks and document the root causes and solutions identified. The BNA app supports bottleneck analysis through a simple, configurable visualizer in three steps. One, visualizes performance data on the supply, demand and quality, or determinants of the effective coverage of interventions. Then two, supports sub-level analysis to identify whether bottlenecks are systemic or localized within certain coverage areas. And three, provides a tool to document the priority bottlenecks and what is causing them. All this in one easy to use application, accessible within DHIS2. So let's take a look at how the DHIS2 bottleneck analysis app works. You can download the BNA app from the app store, and once it's installed, you'll be able to access it straight from the search menu in DHIS2. Inside the BNA app, you can select an intervention from a preset list of interventions, or create a new one using this plus of button. For now, let's look at an example of the BNA in action with the DPT3 immunization intervention. When selecting an intervention to analyze, you can specify the time period and geography. Within the application, you'll find three items, the bottleneck analysis chart, the sub-level analysis table and the root cause analysis table. Let's look at the bottleneck analysis chart first. Here you can see six bars that represent the determinants of coverage of an intervention. The first three bars represent the supply side of our intervention. So one, the availability of essential commodities, in this case vaccines. Two, the availability of trained human resources, such as vaccination teams. And three, geographic accessibility of services, like vaccination centers. The next two bars represent the demand side of the intervention. So the initial utilization, those who take a first vaccine dose. And then the continuous utilization, so those who take a second vaccine dose. The final bar represents the quality of interventions delivered. So the full course of interventions, the results from the combination of supply and demand factors. If the bars do not reach 100%, and when there is a big difference or drop off between bars on the chart, there is a bottleneck or weakness in the health system that needs to be identified. We can see on the supply side a large drop off between the availability of vaccines and trained providers to administer the vaccines. This indicates that there's a challenge with human resources that's contributing to low vaccination rates. You can click on the bar to highlight this analysis and the bar will turn red. Once you've identified bottlenecks, you can use the sub-level analysis table to drill down and review the situation at lower levels of the system. You can see there are some significant differences in the human resource availability across health facilities in the district, as shown in the performance scorecard. In a couple of health centers, a large share of the population must travel long distances to reach the nearest health facility offering vaccinations. A district may want to specifically target the areas in red with their proposed solution. Finally, we can see the root cause analysis table. Once priority bottlenecks have been identified, a team of stakeholders have discussed and identified what the root causes are. You can use the root cause analysis table to document the root causes of identified bottlenecks, along with the proposed solutions for fixing these bottlenecks that can be included in annual operational plans. These can be entered in the table by selecting add new, allowing multiple users to see what the priority bottlenecks, root causes, and prioritized solutions are. Here we can see that the human resources has been highlighted as a priority bottleneck, and that both the root cause and possible solution have been identified and documented. These findings can be shared with team members working with you on your health intervention to facilitate effective follow-up, including monitoring on a monthly or quarterly basis to see if the bottleneck is being reduced based on the solution implemented by using the action tracker app, also available in DHIS2. The DHIS2 bottleneck analysis app is an intuitive tool to help identify, analyze, and document prioritized bottlenecks, root causes, and local solutions. This analysis can be saved and called up later for another date to review its progress. Install it now from the DHIS2 app hub to try it out for yourself.