Inter-organisational Governance Mechanisms and Healthcare Supply Chain Resilience in Dar es Salaam, Tanzania

Abstract

The call for Universal Health Coverage under the Sustainable Development Goals (SDGs) has increased focus on the performance of healthcare service delivery systems. While operational improvements have been widely suggested to boost resilience, the role of inter-organizational governance (IOG) remains underexplored. This study examines how contractual, institutional, and relational mechanisms within the IOG associate with healthcare supply chain resilience (HSCR). A mixed-method approach was used, combining survey data from 365 healthcare supply chain personnel from public healthcare facilities with (n=12) key informant interviews from the Medical Stores Department and Accredited Prime Vendors in Dar es Salaam. Quantitative data were analysed using descriptive statistics and Partial Least Squares Structural Equation Modelling (PLS-SEM) in SmartPLS4, and qualitative interview data were analysed using thematic analysis. The results show that all governance mechanisms are significantly associated with resilience, explaining 47.8% of the variance in HSCR. Contractual governance has the strongest positive association (β = 0.361, p < 0.001), followed by institutional (β = 0.245, p < 0.001) and relational governance (β = 0.212, p = 0.005). This study demonstrates that contractual, institutional, and relational governance mechanisms independently show significant positive associations with healthcare supply chain resilience, with contractual governance mechanisms exhibiting the strongest association. Policy makers and healthcare practitioners should strengthen enforcement of contractual mechanisms, review and streamline institutional procedures to enhance responsiveness, and improve communication and collaborative relationships to support resilience.