This chapter overviews the challenges in pharmaceutical supply chains (PSCs) in Low- and Middle-Income Countries (LMICs), with a focus on Sierra Leone. Furthermore, it describes how traditional supply chain optimization strategies can be used to improve performance of PSCs in Sierra Leone. Finally, it describes the significant potential for using machine learning in this framework for effective demand forecasting. We highlight challenges such as limited data availability, the need to ensure equitable distribution, as well as the potential for transfer learning to address some of these challenges.