Zamanguni Fortunate Kubheka
Abstract
Inefficiencies in supply chain management (SCM) remain a persistent barrier to effective service delivery in rural primary healthcare (PHC) facilities in South Africa. Operational Managers (OMs), tasked with overseeing supply chain processes at the PHC level, face centralised bureaucratic procurement systems, decentralised storage practices, and infrastructural limitations that impede the availability of medical and other supplies as well as service continuity. This study explores supply chain barriers, operational impacts, and improvement strategies from the perspective of operational managers in rural facilities. A qualitative, exploratory study approach was employed. Data were collected through in-depth, semi-structured interviews with 20 OMs across rural PHC clinics in the uMkhanyakude District of KwaZulu-Natal, South Africa. Participants were purposively selected based on direct responsibility SCM oversight. Interviews were transcribed verbatim and analysed using reflexive thematic analysis, supported by NVivo software. The results showed persistent inefficiencies in procurement and supply chain management. Main challenges included centralised and uncoordinated procurement, bureaucratic Non-Stock Item (NSI) ordering processes, lack of direct supplier engagement, and reliance on manual inventory tracking. Infrastructure maintenance delays further exacerbated operational disruptions. These inefficiencies manifested as stock-outs, staff workload imbalances, service delivery interruptions, and compromised patient care. OMs reported resorting to informal emergency procurement and personal financial contributions to sustain facility operations. Recommended strategies included decentralising supplier engagement, digitising inventory management, establishing emergency procurement funds, and providing supply chain training for OMs. Supply chain inefficiencies in rural South African PHC facilities are deeply embedded within centralised procurement systems and technological gaps, placing undue burden on Operational Managers and compromising service delivery. Strategic interventions that decentralise procurement, digitise inventory processes, and empower these frontline managers are urgently needed to strengthen rural health systems. Future research should assess the implementation outcomes of such reforms in resource-constrained clinic settings.