From process integration to resilience: The mediating role of inter-organizational governance in Tanzania's healthcare supply chains

Abstract

Tanzania has implemented several significant reforms to supply chain processes, including integrating the electronic Logistics Management Information System and the Prime Vendor system. However, despite such investments, healthcare continues to experience regular quarterly shortages. The effectiveness of aligning processes to improve supply chain resilience is questioned, underscoring the need to understand how process integration practices translate into preparedness, responsiveness, and recovery during disruption. Adopting a dynamic and relational capability view, this paper examines the influence of process integration on the resilience of the healthcare supply chain and the mediating role of inter-organizational governance. The study population comprises actors involved in healthcare supply chain management, including 153 public facilities from hospitals, health centers, and dispensaries located in 5 districts in Dar es Salaam, Tanzania. The study employed an explanatory sequential mixed-methods design, with data collected from 365 respondents in public healthcare facilities, including hospitals, health centers, and dispensaries, and supported by 12 key informant interviews with key healthcare supply chain institutions, such as the Medical Stores Department and the Accredited Prime Vendors. Quantitative and qualitative tools were used to collect data; quantitative data were collected through questionnaires and analyzed using Smart PLS (Partial Least Squares), while semi-structured interviews guided by thematic analysis were employed to collect qualitative insights to explain the quantitative findings. The findings show that while the dimensions of process integration significantly improve integration, they do not have a direct effect on healthcare supply chain resilience (β = 0.120, p = 0.090). Instead, inter-organizational governance mechanisms account for this relationship, with contractual governance exerting the strongest influence. Evidence from the interviews indicates that although integration improves visibility and coordination of activities, effective responses are driven by inter-organizational governance mechanisms that enable enforcement and the timely coordination of supply chain actors' actions. This study shows that resilience depends more on the inter-organizational governance of integrated activities, highlighting the central role of governance mechanisms in shaping process integration to enable adaptive responses in healthcare supply chains.