Inefficiencies in healthcare supply chain management and their impacts on rural clinics in South Africa

Background: Supply chain management (SCM) inefficiencies continued to undermine service delivery in rural primary healthcare (PHC) facilities in South Africa. Rural primary healthcare facilities depend on reliable procurement, storage and distribution systems to maintain continuity of care, yet these processes are frequently constrained by centralised administrative structures and limited operational autonomy at clinic level. Within resource-constrained settings, such disruptions extend beyond logistical inconvenience, shaping service accessibility, managerial workload and ultimately the quality of patient care. Objectives: This study examined key SCM inefficiencies in rural PHC clinics and analysed their operational and clinical impacts on clinic operations, patient care, service delivery and health outcomes and proposed improvement strategies from operational managers (OMs) and PHC supervisors’ perspectives. Method: A qualitative exploratory design was applied across 61 rural PHC facilities in KwaZulu-Natal’s uMkhanyakude District. Nineteen participants, including 17 OMs and two PHC supervisors, were purposively sampled. Semi-structured interviews were conducted and analysed with NVivo. Results: The study found persistent procurement delays caused by centralised, bureaucratic systems, limited supplier engagement and manual stock tracking. Infrastructure maintenance was slow and uneven, storage was poorly managed, leading to stock-outs, staff overload and service disruptions, which forced OMs to use personal resources to sustain clinic operations. Conclusion: Supply chain management (SCM) inefficiencies significantly constrained PHC clinic operations, diverted managerial attention from clinical oversight and eroded patient trust. Addressing these challenges required decentralised procurement authority, digital inventory systems, targeted managerial training and responsive maintenance mechanisms. Contribution: The study provided empirical evidence from frontline managers: a perspective rarely examined in rural healthcare SCM research. It linked systemic SCM inefficiencies to operational and equity challenges and strengthened SCM scholarship by showing how procurement, inventory, and distribution barriers shape rural PHC performance. By using dynamic capabilities theory, institutional theory, and the SCM operations reference model, this study explained managerial adaptation and identified practical pathways to improve health SCM, guiding policymakers and health leaders to enhance system resilience and advance universal health coverage.