Procurement Bottlenecks in Zambia’s Ministry of Health
A Qualitative Analysis of Systemic Constraints
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Abstract
The availability of essential medicines continues to be a major challenge in many low- and middle-income countries (LMIC), despite ongoing reform efforts. This study analysed procurement bottlenecks affecting availability of essential medicines in Zambia’s Ministry of Health. The paper adopted a qualitative research design and drew on evidence from 30 Key Informant Interviews and 3 Focus Group Discussions held across Lusaka, Kafue, Chilanga and Rufunsa districts. Thematic analysis was used to analyse data in relation to systemic constraints within procurement processes. Findings revealed four primary bottleneck domains in Zambia’s public health procurement system: delayed budget releases; proliferating approval layers and stages; errors in specifications/planning and limited supplier capacity with late deliveries. These constraints cumulatively interact resulting in extended procurement cycles and undermined supply reliability across health facilities. The Analysis, uses the Theory of Constraints, to ascribe procurement inefficiencies to financial synchronization failures and workflow congestion rather than regulatory inadequacy. It then recommends targeted reforms to improve procurement system performance through timely fiscal entry point, streamlined approvals, accurate planning and budgeting and stronger supplier coordination. Thus, efforts to improve the availability of medicines in Zambia’s primary healthcare system need policy interventions that are focused on managing systemic constraints rather than on expanding processes.
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Copyright (c) 2026 Memory Ntaimo, Bupe G. Mutono Mwanza, Chikusela Sikazwe (Author)
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