Reliance on imports and limited domestic manufacturing caused vulnerability to supply chain shocks, including initial high prices for products such as personal protective equipment.

Increased domestic production eventually alleviated shortages and helped reduce prices.

Policies are needed to increase and sustain domestic production of medical products to mitigate supply shocks from disruptions to international supply chains.

Broad restrictions in trade and exports of medical products caused shortages and supply chain delays.

Bilateral and multilateral conventions are needed to prevent blanket restrictions on the movement of medical products during emergencies.

Broader trade policies that prioritize access to essential medicines and medical products are essential for public health.

Competitive bidding processes that required in-person submission of bids and presence during the adjudication of bids precluded participation by international bidders who faced travel restrictions.

Products procured under global pooled procurement with long-term supply agreements were more resilient to supply and price shocks.

Modernizing procurement processes by adopting technological solutions, such as online-based bidding platforms, can build resiliency and flexibility and help sustain the competitiveness of bidding processes.

Pooled procurement at national, regional, and global levels could be an important strategy for fostering supply chain resiliency and improving procurement outcomes.

Disruptions to funding flows from the central level to health facilities hampered health facilities' ability to procure commodities.

The availability of a multilateral support fund for the health sector ensured there were resources to support commodity procurement.

Reserve stocks of essential medicines purchased under the fund were available to bridge supply constraints.

Health system financing reform, including decentralizing funding to local levels, could empower health facilities to improve procurement planning without funding flow uncertainties.

Coordination of development assistance for the health sector among partners and long-term strategic funding investments can foster broader health system resilience.

Provisions for waiver of registration requirements in the regulatory framework allowed imports of products that were in short supply locally.

Regulatory frameworks should have flexible provisions to allow market needs to be met during times of constrained supply and where products are not available locally.

There is a need to ensure that products imported under special provisions are also quality assured.

Innovative service delivery models, such as integrated outreach services, helped ensure continued access to health services amidst access restrictions.

Health systems should explore innovative service delivery models that promote access to health services, encompassing hard-to-reach populations.