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Supply chain
Critical success factors in the management
supply chain management of
essential medicines in the public
health-care system in Malawi
Feston Kaupa and Micheline Juliana Naude Received 8 January 2020
Revised 25 May 2020
School of Management, IT and Governance, University of KwaZulu-Natal, 10 October 2020
Durban, South Africa Accepted 29 November 2020

Abstract
Purpose – The purpose of the paper is to report on a study that investigated the critical success factors (CSFs)
in the supply chain management of essential medicines in the public health-care delivery system in Malawi.
Design/methodology/approach – The exploratory and descriptive study followed a qualitative and
quantitative research approach. Data were collected by means of semistructured interviews and a
questionnaire administered to suppliers of essential medicines, regulators, donors and logistics companies in
Malawi. Data was analyzed using SPSS.
Findings – The findings revealed that the significant CSFs are knowledge of disease patterns and
prevalence, skills and experience of personnel, adequate financial resources, collaboration with supply chain
partners and an efficient procurement and distribution system.
Research limitations/implications – There were a number of limitations in this study. Although
every effort was made to carefully and purposefully select the participants for the in-depth interviews in the
first phase of the study and the respondents for the questionnaire in the second phase of the study, they were
not randomly selected. As such, the findings cannot be generalised to all stakeholders in the pharmaceutical
supply chain in Malawi. However, they can be used as a basis for further research on the topic.
Originality/value – No previous studies that deal with the identification of CSFs in the Malawi
pharmaceutical supply chain were found. Therefore, this research makes a twofold contribution to the body of
knowledge in the field. First, it identifies CSFs; second, it could assist stakeholders in the public health-care
service delivery system in Malawi with regard to how they can improve the supply of essential medicines.
Keywords Malawi, Performance management and benchmarking, Critical success factors,
Business improvement, Pharmaceutical supply chain, Public health-care delivery system
Paper type Research paper

Introduction
Important contemporary issues are critical success factors (CSFs) in public health-care
supply chains. The role of the public health-care sector in improving the availability of
medicines and medical supplies at all levels of the public health delivery system has never
been more important. The pharmaceutical supply chain is organised around four primary
activities, namely, selection, procurement, storage and distribution and use. Management
support systems include planning and administration, organisation, financing, information
technology and human resources (Embrey, 2012, p. 10).

Journal of Global Operations and

Strategic Sourcing
© Emerald Publishing Limited
2398-5364
Dr G Hendry assisted with the statistics and Dr C Goodier with the language editing. DOI 10.1108/JGOSS-01-2020-0004
JGOSS The ultimate goal of supply chain management is to create value for the services and
products provided to end users that in turn will benefit the organisations in the supply chain
(Lysons and Farrington, 2016, p. 87). To accomplish this, organisations within the supply
chain must integrate their processes internally and externally with supply chain partners
(Monczka et al., 2015, p. 15). Supply chain partners will succeed if they identify, manage and
measure the CSFs, with such factors being either enablers or barriers to the attainment of
excellence in supply chain management (Parmenter, 2015).
Governments have a social responsibility to provide health care to their citizens (Kraiselburd
and Yadav, 2012, p. 5). Provision of health care consists of setting up an effective and efficient
national supply chain system. Malawi’s Ministry of Health is responsible for improving the
health and well-being of the population (Ministry of Finance and Economic Planning
Development, 2017, p. 48). To achieve this, the Government of Malawi attaches great importance
to the provision of quality health-care services. Quality health care is equated with availability of
essential medicines and supplies (Nabbuye-Sekandi et al., 2011, p. 4).
Regular stock-outs of essential medicines at the Central Medical Stores Trust and in
public health facilities remain a constant challenge in the delivery of quality health-care
services in Malawi (Central Medical Stores Trust, 2014, p. 6). Causes of stock-outs include
inadequate and unpredictable financing, lengthy and poor procurement management
systems, weak logistical information management systems, inadequate storage and
transport infrastructure, pilferage and theft of supplies in warehouses and during
transportation, receipt of unnecessary donations and receipt of donations of short-dated
(near-expiry date) medicines (Central Medical Stores Trust, 2014, p. 8; Kanyoma et al., 2013,
p. 20). Stock-outs of essential medicines can lead to high incidence of disease and premature
deaths, thereby compromising efficiency and effectiveness as well as affecting the
achievement of the national development goals and objectives for strengthening the public
health-care system in Malawi. Consequently, Khuluza et al. (2016, p. 149) recommend that
further research be undertaken to address the issue of shortages of drugs in Malawi
hospitals.
In view of the various challenges, the scope and complexity of public pharmaceutical
supply chains and the importance of essential medicines in Malawi, the following main
question is addressed in this research:

Q1. What are the critical success factors in the supply chain management of essential
medicines and how significant are they to the public pharmaceutical supplies
system in Malawi?
To answer this research question, the following primary objectives guided the study:
 to identify the CSFs in the supply chain management of essential medicines in the
public health-care system in Malawi; and
 to determine the extent to which these factors affect the supply chain management
in the delivery of health-care services in Malawi.

The study contributes to the current body of knowledge by addressing the gap that exists in
the literature on CSFs, through an exploration of what the CSFs in the supply chain
management of essential medicines in the public health-care system in Malawi are and the
extent to which these factors affect the supply chain management in the delivery of health-
care services. It is envisaged that should the suggested recommendations be implemented, it
would assist stakeholders in the public health service delivery sector to improve the delivery
of essential medicines and supplies in developing countries. Ultimately, this would reduce
the incidence of illness and the occurrence of premature deaths. This study provides a Supply chain
platform for future academic research on CSFs in supply chain management as the results management
could aid researchers in developing the research instrument.
The article first reviews available literature on CSFs and provides an overview of the
pharmaceutical supply chain. This is followed by a description of the research design and
methodology, a report of the findings, including an overview of the Malawi health-care
system, recommendations and finally the conclusion.

Literature review
Critical success factors in supply chain management
CSFs are the building blocks of an organisation’s mission, being vital to organisational
success, strategy formulation and evaluation (Parmenter, 2015). In order for a business to
achieve successful and competitive performance, there will be some areas that are key to its
current operating activities (Boynton and Zmud, 1984, p. 17; Talib and Hamid, 2014, p. 23).
These areas must receive careful attention and be reviewed continuously (Talib et al., 2015,
p. 3).
The concept of identifying and using CSFs was introduced by Rockart in 1979 and was first
used in the field of information systems. Today, CSF analysis is commonly used across a
wide range of fields, most significantly within supply chain management. Supply chain
management is the management of activities involved in the sourcing of materials and services,
the transformation of materials into intermediate and final goods and the transporting of these
goods to end users (Holweg et al., 2015, p. 97; Lummus et al., 2013, p. 18). CSFs must therefore
be identified to assist business leaders to know their organisational strengths, weaknesses,
opportunities, threats, resources and capabilities (Talib et al., 2015, p. 3).
CSFs in supply chain management represent a wide variety of strategies devoted to
improving the operational efficiency and competitiveness of organisations. These factors
should be considered as actions that need to be carefully controlled to achieve goals and
objectives (Irfan and Kee, 2013, p. 62). From numerous CSFs mentioned in supply chain
management literature reviews (Table 1), the “vital few” can be identified. Talib et al. (2015,
p. 9) grouped similar CSFs together in one domain. This process was followed in this article.
In Table 1, the CSFs presented as headings represent the domain factors, whereas the
related CSFs are listed below these. For example, all factors related to participative
management style, such as corporate culture and organisational commitment, are grouped
together under the domain “Top management commitment.”
CSFs can be either enablers or barriers to the attainment of excellence in supply chain
management (Parmenter, 2015). In other words, when CSFs are not controlled and
continually reviewed to achieve goals and objectives, this can create vulnerability in the
supply chain and may present as a risk. Jacobs and Chase (2018, p. 33) remark that supply
chain networks are vulnerable to disruptions and that a failure at any point in the supply
chain may cause the entire network to fail.

Pharmaceutical supply chain of essential medicines in Malawi

A supply chain is a network of all the organisations involved in upstream and downstream
linkages in the various processes of manufacturing, supplying and delivering a finished
product to an end customer (Lysons and Farrington, 2016, p. 76). The activities in a supply
chain include extracting raw materials from the earth, and sourcing and supplying the
materials; manufacturing components; producing and assembling products; storing of
inventory in warehouses; and distribution and delivery of products to the end customer
(Burt et al., 2012, p. 9; Chopra and Meindl, 2016, p. 13; Wisner et al., 2018, p. 7). The
JGOSS
Critical success factors Source

Top management commitment Gibson et al. (2016, p. 474); Glavin and

participative management style; corporate Chilingerian (2010, p. 15); Irfan and Kee
culture; organisational commitment; top (2013, p. 63); Kumar et al. (2015, p. 93); Talib
management support; organisational et al. (2015, p. 9); Talib and Hamid (2014.
involvement; decentralised task management; p. 27)
management capability; role of organisation;
managerial understanding; quality leadership;
allocation of resources; tendency to view
employees as a valuable resource; long-term
vision for survival and growth
Service quality/customer focus Irfan and Kee (2013, p. 63); Talib et al. (2015,
involvement of everyone at all levels; on-time p. 9)
delivery; system quality; information quality;
service quality; ease of use; quality management
capability; quality improvement; primary
customer loyalty; customer support; service as
promised; providing services right the first time;
quick response to customer complaints
Cost minimisation Ambe and Badenhorst-Weiss (2012, p. 244);
cost reduction; cost savings Kumar et al. (2015, p. 93); Talib et al. (2015,
p. 9)
Processes Irfan and Kee (2013, p. 63); Kumar et al.
procurement systems; developing just-in-time (2015, p. 93); Talib et al. (2015, p. 9)
(JIT) capabilities in the system/processes;
outsourcing noncore activities; redesign of the
procurement process; material flow
management; flexibility
Resource capability Irfan and Kee (2013, p. 63); Kumar et al.
resource management; demand forecasting; (2015, p. 93); Talib et al. (2015, p. 9)
price response capability; delivery capability;
flexible capability; financial capability;
warehouse infrastructure; inventory
management system; operational elements;
performance elements; extensive services range
Human resources Menon (2012, p. 782); Irfan and Kee (2013,
selective hiring; fairness at all levels; skilled and p. 63); Talib et al. (2015, p. 9); Wu et al.
experienced professionals; knowledge (2014, p. 123)
management (market and product); training and
education programmes; teamwork; formation of
a project team, committed employees; employee
empowerment; employee satisfaction
Use of information technologies Christopher (2016, p. 146); Irfan and Kee
computer-based technology; technology (2013, p. 63); Kumar et al. (2015, p. 93); Talib
utilisation; reliability of hardware and software; et al. (2015, p. 9); Talib and Hamid (2014,
effective use of data; e-procurement system p. 27)
compatibility with other systems; technology
capacity and capability; quality of IT system;
information quality; effective customer care
system; effective communication system; use of
advanced technology; strategic use of IT;
Table 1. documented procedures
Critical success (continued)
factors in literature
 Supply chain
Critical success factors Source
management
Open communication Kumar et al. (2015, p. 93); Talib et al. (2015,
communication, cross-organisation p. 9)
communication, openness, constant
communication
Trust Irfan and Kee (2013, p. 63); Kumar et al.
trust, mutual trust, confidence, transparency; (2015, p. 93); Talib et al. (2015, p. 9)
trust development in SC partners
Supplier relationships Fawcett et al. (2015, p. 645); Irfan and Kee
capacity of suppliers; partnership with (2013, p. 63); Kumar et al. (2015, p. 93); Talib
suppliers; inter-firm collaboration; supplier et al. (2015, p. 9); Talib and Hamid (2014,
management; relationship with 3PLs; p. 27)
interdependent cooperation; supply chain
partnership selection; supply chain integration;
project collaboration
Market competence Christopher (2016, p. 3); Kumar et al. (2015,
understand market requirements; pressure from p. 93)
competitors; competitive nature
Government intervention Talib et al. (2015, p. 9)
government policies; perceived usefulness;
support activation; policies and regulation
Governance, accountability and social Ambe and Badenhorst-Weiss (2012, p. 244);
responsibility Irfan and Kee (2013, p. 63); Kumar et al.
organisation believes in corporate citizenship; (2015, p. 93); Talib et al. (2015, p. 9)
treating all type of customers at equal level;
service centres easily accessible to the
customers; sense of public responsibility;
fairness, equitability and transparency

Source: Compiled by the authors Table 1.

pharmaceutical supply chain for essential medicines follows a prescriptive stage-by-stage

continuous process that ensures compliance with the Malawi Public Procurement Act
(Ministry of Finance and Economic Planning Development, 2003) and the Malawi Public
Procurement Guidelines (2004). This process comprises the following:
 selection of essential medicines;
 demand, forecasting and planning;
 procurement; and
 warehousing and distribution.

An overview of each of these stages follows.

Stage 1: selection of essential medicines. The World Health Organisation (WHO) has
defined essential medicines as:
[. . .] those which satisfy the needs of the majority of the population and therefore should be
available all the time, in adequate amounts, in appropriate dosage forms and at a price the
individual and community can afford (Embrey, 2012, p. 6).
The essential medicines list of the WHO serves as a model for country-specific national
essential medicines. The model was first developed in 1977 and is updated every two years
(Embrey, 2012, p. 6; Mahmic-Kaknjo et al., 2018, p. 5).
JGOSS The process of selecting essential medicines should begin with defining a list of common
diseases, and the treatment of first choice for each health problem should form the basis for
the list of essential medicines (Mahmic-Kaknjo et al., 2018, p. 5). The selection involves
choosing high-quality essential medicines in appropriate dosage forms and strength. The
selection and use of a limited number of essential medicines leads to an improved supply of
medicines, more rational prescribing and lower costs in health-care delivery (Laing and
Tisocki, 2017, p. 7).
Stage 2: demand forecasting and planning. One of the aims of supply chain management
is to match supply and demand, both of which are uncertain. Demand forecasting and
planning, therefore, entail an understanding of the real market requirements to ensure that
products are made available at the right time, in the right quantities and at the right place
and time (Christopher, 2016, p. 312; Stevenson, 2012, p. 562).
The Central Medical Stores rely heavily on forecasts prepared by the Ministry of Health
to estimate and plan for customer demand. Forecasting uses all data that provides an
estimate of past and future consumption of medicines. According to the National
Quantification and Supply Planning Report (Ministry of Health and Population, 2018, p. 8),
data used for forecasting includes consumption data, service data, and demographic/
morbidity data. Consumption data represents an estimate of the total consumption of all
health facilities at all levels in the country. Service data is derived from a variety of sources
related to specific services and the number of visits or treatments for various illnesses/
conditions, whereas demographic data includes population census data and data from other
demographic and health surveys.
Stage 3: public procurement. Ambe and Badenhorst-Weiss (2012, p. 244) define public
procurement as:
[. . .] the function whereby public sector organisations acquire goods and services from suppliers
in the local and international market, subject to the general principles of fairness, equitability,
transparency, competitiveness, and cost-effectiveness.
It includes a number of activities that support the service delivery of government
departments, parastatals and local authorities, ranging from routine items to complex
development projects. Public procurement also supports government’s social and political
objectives.
Public procurement performs a key function in service delivery and in the performance of
government departments. It is governed by procurement laws and regulations and differs
from one country to another, involving all the processes related to the procuring of goods
and services by government entities (Dzuke and Naude, 2017, p. 2). Finances used are from
state budgets, local authority budgets, state foundation funds, domestic or foreign loans and
foreign aid (Ambe and Badenhorst-Weiss, 2012, p. 244).
However, it is claimed that many developing countries suffer from inefficient,
nontransparent and corrupt procurement procedures. In countries with weak public
governance, funds may be used for overpriced drugs because of rigged procurement
processes (Seiter, 2010, p. 45). Corruption in the health sector is a concern in all countries, but
particularly so in most developing countries, where public resources are severely
constrained. It is estimated that in many developing countries, over 80% of the population
have experienced corrupt practices in the health sector (Hope, 2015, p. 383).
The Central Medical Stores Trust procures medicines and other health commodities in
adherence to the policies and guidelines of the Office of the Director of Public Procurement.
The Trust uses various procurement methods that include single sourcing, request for
quotations, national competitive bidding and international competitive bidding (CMST
2015–2020 Business Plan, 2015, p. 15). When health commodities are not available from Supply chain
existing stock or when stock reaches re-order levels and needs replenishing, this is indicated. management
Stage 4: warehousing and distribution. Distribution involves delivering commodities to
customers at the right time and in the right quantity and volume, requiring high levels of
planning and coordination between the organisation, its customers and other components of
distribution such as transportation, warehousing and repackaging services (Naude, 2009,
p. 105; Wisner et al., 2018, p. 349).
Essential medicines are distributed from a warehouse at the central level to the three
regional medical stores, namely, the Region Medical Stores South, Region Medical Stores
Centre and Region Medical Stores North. The medicines are redistributed from the regional
stores to the five central hospitals, 28 district hospitals and over 700 health centres
throughout the country (Central Medical Stores Trust, 2015, p. 16).

Overview of the Malawi health-care system

The Malawi health-care system comprises a private and public sector. The private sector
consists of for-profit and faith-based organisations. For-profit health care is provided by
private hospitals, clinics, laboratories, pharmacies and traditional healers. Faith-based
organisations include the Christian Health Association of Malawi, nongovernmental
organisations, statutory corporations and private organisations, who provide the private-
not-for-profit health care. Services provided by the public health care are free of charge,
whereas the private sector providers charge user fees for their services (Chana, 2011, p. 2;
Ministry of Health and Population, 2016, p. 15). The health system is divided into four levels,
namely, the community and the institutions at a tertiary, secondary and primary level
(Chana, 2011, p. 2). These levels of health care are intertwined through a referral system.
Community, primary and secondary levels of care fall under the District Health Officer
within district/town/city council systems that are under the overall supervision of the
District Commissioner. Health surveillance assistants at dispensaries, village clinics and
maternity clinics provide community level health care. Health surveillance assistants mainly
promote and provide health care through door-to-door visitations and village, outreach and
mobile clinics (Frenkel et al., 2015, p. 986; Ministry of Health and Population, 2017, p. 2).
At the tertiary level, health care is delivered by central hospitals. There are five central
hospitals in Malawi, which provide specialist health services at a regional level and referral
services to the district hospitals within their regions. In addition to referral services, they
also provide essential health package services (Chana, 2011, p. 2; Ministry of Health and
Population, 2017, p. 2).
The secondary-level health service providers are the district and Christian Health
Association of Malawi hospitals. These hospitals provide general services and primary
health-care services to outpatients, inpatients and the surrounding community. In addition,
they provide training and support to community-based health programmes and are
managed by a district health management team (Chana, 2011, p. 2; Frenkel et al., 2015,
p. 986).
At the primary level, health-care or community care provision is undertaken by health
surveillance assistants, community-based distributing agents, community health nurses
and other volunteers within community and institutional settings. Institutional settings
consist of community initiatives, health posts, dispensaries, maternities, health centres and
community and rural hospitals (Chana, 2011, p. 1; Frenkel et al., 2015, p. 986).
Within this system, the Ministry of Health is the policyholder, setting the standards of
health care and providing technical support as well as monitoring and evaluation services.
JGOSS In addition, the Ministry of Health mobilises resources and develops strategic plans for the
whole health sector (Ministry of Health and Population, 2017, p. 3).

Method of research
This is an exploratory and descriptive study, and qualitative and quantitative method
techniques were adopted. The purpose of the empirical research was to: identify the CSFs in
the supply chain management of essential medicines in the public health-care system in
Malawi; and determine the extent to which these factors affect the supply chain
management in the delivery of health-care services in Malawi. A semi-structured interview
guide and a structured questionnaire were designed to achieve this.
The interview guide consisted of open-ended questions that were intended to elicit the
views and opinions of participants about the CSFs for pharmaceutical supply chain
management. The questionnaire consisted of two parts. The first part provided general
information on the profile of the respondents. The second part comprised a number of closed
and open-ended questions generated from the literature review and the results of the
qualitative data analysis. The closed questions comprised five sections relating to
the pharmaceutical supply chain in Malawi. Items were measured on a seven-point Likert
scale, varying from 1 (to a lesser extent) to 7 (to a greater extent). A statistician checked the
questionnaire to ensure that the formulation of the questions was clear and easily
understood by the respondents. Then, the questionnaire was pilot tested with a sub-sample
of the target population to assess whether it would be able to achieve the intended objectives
(Saunders et al., 2016, p. 473).

Sampling
A target population can be defined as “the entire group of individuals or objects to which
researchers are interested in generalising the conclusions” (Sekaran and Bougie, 2016, p. 56).
The target population of this study were 134 organisations from the public and private
sectors in Malawi. These comprised: 120 suppliers of essential medicines from the Central
Medical Stores Trust database of suppliers, the national medicines regulatory authority, the
national procurement regulatory authority; 12 members of the health donor group; and two
pharmaceutical logistics companies that distribute medicines to public health facilities.
A nonprobability judgement sampling technique was used to identify 12 participants
and 31 respondents based on their expertise, knowledge and experience in pharmaceutical
supply chain. Hence, experts that were not readily available or unable to articulate
pharmaceutical supply chain matters were excluded from the sample. Five possible
respondents were excluded as they had participated in the pilot study. The results of the
pilot study are not included in this study.

Data collection
Face-to-face interviews were conducted with the 12 participants, using the semi-structured
interview guide. The interviews were conducted by one of the authors and were recorded
using a digital voice recorder. The recorded interviews were transcribed verbatim and
checked against the recordings for accuracy. Data were analysed using thematic analysis.
Using this data, a questionnaire was designed that included the CSFs identified from the
literature and the semi-structured interviews. Table 2 presents the profile of the participants.
The questionnaire used a 7-point Likert scale ranging from 1 = to a lesser extent, to 7 =
to a greater extent. If the various CSFs that were listed in the questionnaire were not
applicable, the respondents had the option of ticking a “Not a CSF” box. The questionnaire
was administered via email to 31 senior and middle-level managers as an on-line
questionnaire. Respondents were informed by telephone of the purpose and objectives of Supply chain
the study to obtain their participation and co-operation. A covering letter with the management
questionnaire was sent in an email immediately after the respondent had agreed to take part
in the research. To improve the response rate, respondents who had not returned the
questionnaire by the predetermined date were reminded telephonically and fresh
questionnaires were sent. No incentives were offered to encourage participation. All 31
respondents completed and returned the questionnaire; therefore, the study achieved a
100% response rate.

Data analysis
The completed questionnaires were coded, and the responses captured in Excel by one of
the authors. Once this was done, a statistician exported the data into SPSS version 22.0. The
responses to the questionnaire on the CSFs were analysed using a binomial test to determine
whether a particular factor is deemed by a significant proportion of the respondents to be
a CSF. A binomial test is an exact test of the statistical significance of deviation from a
theoretically expected distribution of observations into two categories. It tests whether a
significant proportion of respondents select one of a possible two responses. It is set at the
5% level of significance. Thereafter, each identified CSF was tested to determine the extent
to which the average score of that factor is significantly different from a central score of 4,
using the Wilcoxon signed rank test. The Wilcoxon signed rank test is a non-parametric
test, used to test whether the average value is significantly different from a value of 4 (the
central score). In this study, a p-value of <0.0005 shows that the value is significantly
different from 4. The assumption is that the variable being tested is symmetrically
distributed about the median, which would also be the mean.
The descriptive statistics were used as an aid to explain the qualitative data. The
qualitative comments were transcribed in a report format, after which it was possible to
review, compare and combine the findings of each respondent. One of the authors checked
the transcripts for accuracy and correctness.

Reliability and validity

Prior to administration, the questionnaire was pilot tested to assess the validity and
reliability of the data to be collected. A pilot study can be defined as a trial study to
“road-test” the questionnaire with a subsample of the target population to assess the
merits of its design, its appropriateness and whether it was able to achieve the intended

Interviewee Designation Nature of organisation Sector

Participant 1 Supply chain advisor Bilateral development partner Donor

Participant 2 Senior logistics officer Procurement and supply chain management Public
Participant 3 Supply chain advisor Bilateral development partner Donor
Participant 4 Director Procurement and supply chain management Public
Participant 5 Director Procurement and supply chain management Public
Participant 6 Logistics manager Logistics service provider Private
Participant 7 Registrar Medicines regulator Public
Participant 8 Hospital director Central hospital Public
Participant 9 Quality assurance manager Procurement and supply chain management Public
Participant 10 Deputy director Government health department Public
Participant 11 Procurement manager Procurement and supply chain management Public Table 2.
Participant 12 Supply chain advisor Bilateral development partner Donor List of participants
JGOSS objectives (Saunders et al., 2016, p. 473). A sub-sample of five respondents of the target
population were included as part of the pilot test. These respondents were considered
suitable because of their expert knowledge about the pharmaceutical supply chain in
Malawi.

Findings
Profile of respondents
Table 3 presents the details of the gender, age and employment position of the respondents
that participated in this study (N = 31).

Stage 1: selection of essential medicines

The CSFs in the selection of essential medicines, identified in literature and from the
findings of the interview stage of the study, were incorporated as items in the questionnaire.
Table 4 presents the extent of these CSFs.
“Knowledge of disease patterns and prevalence” (M = 6.23) received the highest rating,
which demonstrates that respondents attached the greatest significant importance to this
critical success area compared with the others. This finding is in line with those of Wu et al.
(2014, p. 123), who identified knowledge management as a CSF for a responsive supply
chain. Successful supply chain management depends on the skills-mix and knowledge of the
people managing the supply chain (Monczka et al., 2015, p. 21). The pattern of prevalent
diseases in Malawi is uniform. Almost all the hospitals experience the same common types
of cases. Consequently, knowledge of the pattern of prevalent diseases in Malawi becomes a
CSF as it influences the essential medicines to be selected and quantified.
“Availability of up-to-date standard treatment guidelines from which to select the
essential medicines to be procured and supplied to the public health facilities” (M = 6.07)
received the second highest rating, which demonstrates that respondents attached
significant importance to this critical success area compared to the others. The standard
treatment guidelines for medicines recommended for the treatment of various ailments are
made available as a reference document. This document needs to be updated regularly
because some medicines could have been deregistered by the WHO, whereas others could
have been taken off the list of recommended medicines because of causing adverse reactions.
“Cost of medicines and their associated treatment costs” (M = 5.76) received the third
highest rating. There are many factors to be considered in the selection of essential
medicines, such as prevalence of diseases, cost of medicines and overall treatment. Cost
considerations can be met by selecting medicines that are multipurpose and not those that
are specific to only one kind of ailment. One type of medicine should be able to treat a wide
range of ailments. Selection should also aim at reducing branded products to reduce the cost
of medicines.
Respondents placed less importance on the CSFs “the diversity of registered essential
medicines from which to select the medicines to be procured and supplied to public health
facilities” (M = 5.36) and “knowledge of the pharmaceutical market” (M = 4.97) CSFs. These
factors received the lowest mean ratings. As Malawi is restricted to the selection and
procurement of registered products only, there needs to be an increase in the number of
manufacturers registering for the same product to widen the product range and competition,
the situation requires increasing. Pharmacists employed by the Central Medical Stores Trust
should be instrumental in influencing the demand and selection of health commodities by
customers, based on their knowledge of the products and the market. The Central Medical
Stores Trust supplies public health facilities, namely, central hospitals, district hospitals and
health centres.
 Age Nature of respondent’s
Supply chain
Respondent Gender (years) Employment position organisation management
Respondent 1 M 30–39 General manager Medicines manufacturer
Respondent 2 M 30–39 District health officer District hospital
Respondent 3 F >40 Procurement and supply Government health
chain specialist department
Respondent 4 M 30–39 Pharmacist District hospital
Respondent 5 M 30–39 District pharmacist District hospital
Respondent 6 M 30–39 Principal pharmacist Government health
department
Respondent 7 M 30–39 Operations manager/ Logistics company
supply chain
Respondent 8 M 30–39 District pharmacist District hospital
Respondent 9 M 30–39 District health officer District hospital
Respondent 10 M >40 Chief professional Procurement regulator
development officer
Respondent 11 M >40 Branch manager Procurement and supply chain
management
Respondent 12 F 30–39 Reproductive health UN agency
commodities specialist on
commodities
Respondent 13 M >40 General manager Procurement and supply chain
management
Respondent 14 M >40 Pharmacy technician District hospital
Respondent 15 F >30 District health officer District hospital
Respondent 16 M >40 Branch manager Supply chain organisation
Respondent 17 M 30–39 Hospital pharmacist Central hospital
Respondent 18 M >40 Warehousing manager Procurement and supply chain
management
Respondent 19 M >40 Chief inspector Medicines regulator
Respondent 20 F >40 Managing director Medicines manufacturer
Respondent 21 M 30–39 District health officer District hospital
Respondent 22 F >40 Regional manager Logistics company
healthcare
Respondent 23 M >40 Technical director Medicines manufacturer
Respondent 24 M 30–39 Supply chain officer UN agency
Respondent 25 M >40 Chief executive officer Medicines manufacturer
Respondent 26 M 30–39 Supply chain specialist Bilateral development partner
Respondent 27 F >40 Programme manager Bilateral development partner
Respondent 28 M 30–39 Country supply chain Logistics company
manager
Respondent 29 F >40 Pharmacy/supply chain Faith-based health
manager organisation
Respondent 30 F >40 Reproductive health/ Procurement and supply chain
family planning supply management Table 3.
chain specialist Profile of
Respondent 31 M 30–39 District pharmacist District hospital respondents

Stage 2: demand forecasting

The CSFs in the forecasting of demand of essential medicines, identified in the literature and
from the findings of the interview stage of the study, were included as items in the
questionnaire. Table 5 presents the extent of these CSFs.
JGOSS Observed proportion Mean score of
Critical success factors who consider the item the extent of Decision: extent
No. (CSF) a CSF (%) being a CSF p-value of CSF

1 Knowledge of disease 100 6.23 p < 0.0005 Greater extent

patterns and prevalence
2 Availability of up-to- 100 6.07 p < 0.0005 Greater extent
date Standard
Treatment Guidelines
from which to select the
essential medicines to be
procured and supplied
to public health facilities
3 Cost of medicines and 97 5.76 p < 0.0005 Greater extent
their associated
treatment costs
4 The diversity of 86 5.36 p = 0.005 Greater extent
Table 4. registered essential
Extent of critical medicines from which to
select the medicines to
success factors in
be procured and
selection of essential supplied to public health
medicines: Wilcoxon facilities
signed rank tests 5 Knowledge of the 100 4.97 p = 0.043 Greater extent
(N = 31) pharmaceutical market

Observed proportion Mean score of

who consider the item the extent of Decision: extent
No. Critical success factors (CSF) a CSF (%) being a CSF p-value of CSF

1 The accuracy and/or 100 6.73 p < 0.0005 Greater extent

completeness of the data used
in demand forecasting and
planning of essential
medicines
2 Collaboration of supply chain 100 6.70 p < 0.0005 Greater extent
partners in coordinating
sources of data for demand
forecasting and planning in
order to avoid overstocking or
understocking of essential
medicines
Table 5. 3 The skills and experience of 100 6.40 p < 0.0005 Greater extent
Extent of critical the people that forecast and
plan for the demand of
success factors in
essential medicines
demand forecasting 4 The adequacy of financial 93 5.93 p < 0.0005 Greater extent
and planning for resources needed for the
essential medicines essential medicines planned
(N = 31) for
“The accuracy and/or completeness of the data used in demand forecasting and planning of Supply chain
essential medicines” (M = 6.73) received the highest rating, which demonstrates that management
respondents attached greater significant importance to this critical success area than any of
the others. Data is important to inform robust demand forecasting and planning,
particularly in health-care systems. Accordingly, the Central Medical Trust makes sure that
the data used in forecasting and quantification is of a high quality. This is achieved by
developing biannual product demand forecasts based on the actual historical orders
received from facilities and by using consumption data obtained from stakeholders and
clients involved in the provision of health care (Central Medical Stores Trust, 2015, p. 25).
“Collaboration of supply chain partners in coordinating sources of data for demand
forecasting and planning to avoid overstocking or understocking of essential medicines”
(M = 6.70) received the second highest rating, which demonstrates that respondents
attached greater significant important to this critical success area than most of the others.
Collaborative partnerships are one of the four major CSFs in supply chain management
(Talib and Hamid, 2014, p. 22). As there are many stakeholders providing support in the
health sector, there is a need for efficient and elaborate collaboration at the demand planning
stage to establish synergy and partnership among the various stakeholders. Such
collaboration would minimise duplication of efforts and ensure effective utilisation of
resources in planning, procurement, warehousing and distribution of health commodities.
“The skills and experience of the people that forecast and plan for the demand of
essential medicines” (M = 6.40) received the third highest rating. It is key that staff have the
requisite skills and experience in demand planning and quantification. This is in line with
the findings of Talib et al. (2015, p. 9) and Wu et al. (2014, p. 123), who identified skilled and
experienced professionals as a key CSF in supply chain management.
“The adequacy of financial resources needed for the essential medicines planned for”
(M = 5.93) received the lowest rating; however, it is still significant. Demand planning and
forecasting for essential medicines requires an assurance and commitment of adequate
financial resources for the procurement of the medicines. Assurance of the financial
resources and making the finances readily available at the time of procurement also
motivates the demand planners to come up with accurate demand forecasts and plans.
Non-availability of adequate resources would turn the planning, procurement and
availability of medicines into a useless exercise. If government does not pay for the
medicines, then the Central Medical Stores Trusts will not be able to procure them, which
will result in stock-outs.

Stage 3: procurement of essential medicines

The CSFs in the procurement of essential medicines, identified in the literature and from the
findings of the interview stage of the study, were included as items in the questionnaire.
Table 6 presents the extent of these CSFs.
“Availability of adequate financial resources to meet procurement obligations” (M =
6.79) received the highest rating, which demonstrates that respondents attached greater
significant importance to this critical success area than any of the others. Procurement of
essential medicines requires an assurance and commitment of financial resources to meet
obligations that arise from the procurement. Non-commitment and unavailability of
financial resources would lead to unpaid bills and consequently court battles.
“An efficient procurement system, with short lead times, that procures high-quality
medicines at competitive prices” (M = 6.41) received the second highest rating, which
demonstrates that respondents attached significant importance to this CSF. The
procurement cycle starts with the selection of medicines, followed by the determination of
JGOSS Observed
proportion who Mean score of
consider the item the extent of Decision: extent
No. Critical success factors (CSF) a CSF (%) being a CSF p-value of CSF

1 Availability of adequate 100 6.79 p < 0.0005 Greater extent

financial resources to meet
procurement obligations
2 An efficient procurement 100 6.41 p < 0.0005 Greater extent
system, with short lead times,
that procures high-quality
medicines at competitive
prices
3 The collaboration and 97 6.18 p < 0.0005 Greater extent
coordination of stakeholders
involved in the procurement
of essential medicines
4 People with adequate skills 100 6.17 p < 0.0005 Greater extent
and experience in the
procurement of essential
medicines
5 Accuracy of specifications of 100 5.86 p < 0.0005 Greater extent
medicines and estimates of
demand for essential
medicines
6 Capacity of suppliers and 96 5.78 p = 0.001 Greater extent
manufacturers to meet
procurement requirements for
essential medicines
Table 6. 7 Appropriate governance and 100 5.76 p < 0.0005 Greater extent
accountability systems so
Extent of critical
that checks and balances are
success factors in in place to ensure that
procurement of medicines are procured
essential medicines appropriately and accounted
(N = 31) for

demand and the quantities to be purchased with the allocated funds. There are several
factors needed to build up a robust procurement system, including tendering processes, lead
times, availability of finances to pay suppliers, availability of well-trained and experienced
personnel and appropriate procurement management information system. In addition, there
is a need for an efficient and transparent procurement system that meets international
standards, set by stringent regulatory authorities.
“The collaboration and coordination of stakeholders involved in the procurement of
essential medicines” (M = 6.18) received the third highest rating. Strategic alliances create
long-term relationships, leading to the quick resolution of problems and a reduction in the
cost of doing business between supply chain partners (Bowersox et al., 2013, p. 353). Co-
ordination in pharmaceutical supply chains to improve national and global health remains
key (Privett and Gonsalvez, 2014, p. 228).
“People with adequate skills and experience in the procurement of essential medicines”
(M = 6.17) received the fourth highest rating. Crucial in supply chain management is to have
a robust procurement team that is equipped with specialists. These specialists will not only
offer evidence-based guidance to the top management but will also help to interpret the laws Supply chain
and implement the appropriate policy mechanisms (Goldberg, 2010, p. 333). management
The results show that “accuracy of specifications of medicines and estimates of demand
for essential medicines” received a score M = 5.86. The findings revealed that in the past,
there have been challenges in specifications, resulting in some bidders failing to understand
the Central Medical Stores Trust specifications for medicines and medical supplies.
“Capacity of suppliers and manufacturers to meet procurement requirements for
essential medicines” and “appropriate governance and accountability systems so that
checks and balances are in place to ensure that medicines are procured appropriately and
accounted for” received the same rating score (M = 5.76). It was found that theft and
pilferage of medicines along the entire pharmaceutical supply chain is one of the major
challenges in the supply of essential medicines to health facilities. It would appear that there
is a need for control mechanisms and accountability to halt this practice.

Stage 4: warehousing and distribution of essential medicines

The CSFs in the warehousing and distribution of essential medicines, identified in the
literature and from the findings of the interview stage of the study, were included as items in
the questionnaire. Table 7 presents the extent of these CSFs.
“An efficient and secured distribution system that will, for example, avoid duplication of
orders, dispatch orders with minimal delay, loss of essential medicines and so on” (M = 6.65)

Observed
proportion who Mean score of
consider the the extent of Decision: extent
No. Critical success factors item a CSF (%) being a CSF p-value of CSF

1 An efficient and secured 100 6.65 p < 0.0005 Greater extent

distribution system that will, e.g.
avoid duplication of orders;
dispatch orders with minimal
delay, loss of essential medicines,
etc.
2 The adequacy and appropriateness 100 6.39 p < 0.0005 Greater extent
of a warehouse inventory
management system
3 The skills and experience of people 100 6.04 p < 0.0005 Greater extent
managing stocks of essential
medicines in the warehouses
4 Support and commitment from 94 6.03 p < 0.0005 Greater extent
management regarding
improvement of the distribution
infrastructure (e.g. size and types
of vehicles, systems)
5 Use of information technology to 100 5.47 p = 0.002 Greater extent Table 7.
track distribution vehicles of Extent of critical
essential medicines
success factors in
6 The adequacy of storage space of 100 5.11 p = 0.037 Greater extent
owned/rented warehouses warehousing and
7 Outsourcing of distribution 97 4.10 p = 0.980 Neither a lesser distribution of
services nor greater essential medicines
extent (N = 31)
JGOSS received the highest rating, which demonstrates that respondents attached greater
significant importance to this critical success area than any of the others. Malawi is more
dependent on road transport than any other form of transport. With road transport, the main
challenge is the conditions of the roads, especially in rural areas. One participant
commended the Central Medical Stores Trust for owning the appropriate fleet of vehicles to
deal with the terrain of Malawi.
“The adequacy and appropriateness of a warehouse inventory management system”
(M = 6.39) received the second highest rating, which demonstrates that respondents
attached significant importance to this critical success area. Information technology
software and platforms support end-to-end supply chain activities (Nair et al., 2009, p. 23). A
management information system adds value and contributes to the competitive advantage
of an organisation. Thus, the availability of a robust inventory management information
system becomes a CSF in the warehousing operations of Central Medical Stores Trust.
“The skills and experience of people managing stocks of essential medicines in the
warehouses” (M = 6.04) received the third highest rating, which demonstrates that respondents
attached significant importance to this critical success area. In any organisation, attracting and
retaining good quality staff with the appropriate skills mix is a CSF (Talib et al., 2015, p. 9; Wu
et al., 2014, p. 123). Ongoing learning and capacity development should take into account human
resources management and development (Menon, 2012, p. 782).
“Support and commitment from management regarding improvement of the distribution
infrastructure (e.g. size and types of vehicles, systems)” (M = 6.03) received the fourth
highest rating. The organisational support systems that are required to achieve an
organisation’s supply chain objectives are formal systems of communication, co-ordination,
control, authority and responsibility (Gibson et al., 2016, p. 474; Kumar et al., 2015, p. 93;
Talib et al., 2015, p. 9). Top management support and commitment is important for the
success of a supply chain strategy. Top management support and commitment comes
through resource allocation, development and implementation of staff management and
reward systems, and development of robust strategic supplier relationships (Glavin and
Chilingerian, 2010, p. 15).
“Use of information technology to track distribution vehicles of essential medicines” received a
rating of M = 5.47. Automation of the transport system is one way of applying information
technology in the distribution of medicines. Information technology provides a platform on which
supply chain partners can share information easily and at a lower cost (Liu et al., 2013, p. 67).
“The adequacy of storage space of owned/rented warehouses” received a rating of M =
5.11. The Central Medical Stores Trust owns its own warehouses. The number of
warehouses the Trust owns is sufficient, and this is one of the CSFs in its operations. As a
result, the Central Medical Stores Trust is able to distribute essential medicines to all public
health facilities, regardless of geographical location and terrain. This is in line with findings
in the literature that it is not sufficient to take items from the source to the destination, but
the distribution system also needs to be responsive and co-ordinated. Therefore, distribution
includes the development of strategies for managing customer relationships as well as the
designing and building of a dependable distribution network (Wisner et al., 2018, p. 349).
“Outsourcing of distribution services” (M = 4.10) received the lowest rating, which
demonstrates that respondents do not attach significant importance on this critical success area.

Discussion
Summary of critical success factors and recommendations
It is clear from the findings that the CSFs that were rated by respondents to “a greater
extent” significantly affect the performance of the essential medicines supply chain and
service delivery in the public health-care system in Malawi. These findings are in line with Supply chain
the observations of Parmenter (2015) that, should actions related to CSFs not be controlled management
and continually reviewed to achieve goals and objectives, this can create vulnerability in the
supply chain.
The first objective of this study was to analyse CSFs in the supply chain management of
essential medicines in the public health-care service delivery system. The second objective
of this study was to determine the extent of these factors affecting the supply chain
management in the delivery of health-care services in Malawi. A summary of the significant
CSFs is outlined in Table 8.

Practical implications
It is suggested that the CSFs presented in Table 8 are important because, to achieve supply
chain success in the delivery of health-care services, these factors must receive careful
attention and be reviewed continuously. Stakeholders in the public health-care service
delivery system need to make decisions timeously so that they can determine which

Stages in pharmaceutical supply chain of

essential medicines in Malawi Critical success factor

Stage 1: selection and quantification Knowledge of disease patterns and prevalence

Stage 2: demand forecasting and planning
Stage 3: procurement
Stage 4: warehousing and distribution
Availability of up-to-date standard treatment guidelines
Cost of essential medicines and their associated treatment
costs
The accuracy and/or completeness of the data used in
demand forecasting and planning of essential medicines
Collaboration of supply chain partners in coordinating
sources of data for demand forecasting and planning to avoid
overstocking or understocking of essential medicines
The skills and experience of the people that forecast and plan
for the demand of essential medicines
The adequacy of financial resources needed for the essential
medicines planned for
Availability of adequate financial resources to meet
procurement obligations
An efficient procurement system, with short lead times, that
procures high-quality medicines at competitive prices
The collaboration and coordination of stakeholders involved
in the procurement of essential medicines
Skills and experience in the procurement of essential
medicines
Accuracy of specifications of medicines
Capacity of suppliers and manufacturers to meet procurement
requirements for essential medicines
Appropriate governance and accountability systems
An efficient and secured distribution system
The adequacy of storage space of owned/rented warehouses
The skills and experience of people managing stocks of
essential medicines in the warehouses
Support and commitment from management Table 8.
Use of information technology Summary of
The adequacy and appropriateness of a warehouse inventory significant critical
management system success factors
JGOSS resources or tasks require their immediate attention (Talib et al., 2015, p. 24); the identified
CSFs can assist them in making decisions. By focusing their efforts and resources on these
factors, stakeholders in the public health-care service delivery system will have important
information that is necessary for effective service delivery.
Major findings on critical success factors in selection of medicines. Knowledge of disease
patterns and their prevalence, the cost of essential medicines and their associated treatments
and the availability of up-to-date standard treatment guidelines are significant success
factors in the public health-care service delivery system. The high cost of medicines and the
associated treatment costs negate the inclusion of some medicines in the standard treatment
guidelines manuals. Pharmaceutical companies should strive to convince hospital
therapeutic committees and pharmacy managers that their medicines are sufficiently cost-
effective so that they can be included in the standard treatment guidelines (Hassan et al.,
2018, p. 83). As the availability of up-to-date standard treatment guidelines from which to
select the essential medicines to be procured and supplied to public health facilities is a key
CSF, it is important that these be regularly updated.
Major findings on critical success factors in demand forecasting and planning of essential
medicines. The research findings indicate that the CSFs highlighted in Table 8 with regard
to demand forecasting and planning are significant success factors; their absence would be a
challenge to the attainment of excellence in the supply chain management of essential
medicines in the public health-care service delivery system in Malawi.
For example, using inaccurate and/or incomplete data in demand forecasting and
planning of essential medicines leads to poor procurement planning, procurement of low-
quality medicines and the procuring of medicines at uncompetitive prices. This problem
could be exacerbated by a lack of necessary skills and experience. Lack of collaboration
amongst supply chain partners in co-ordinating sources of data for demand forecasting and
planning can lead to overstocking and drug expiries or understocking and stock-outs of
essential medicines and the consequent loss of lives.
Recognising that it is the responsibility of the Central Medical Stores Trust to meet and
satisfy customer demand, the Central Medical Stores Trust should take a leading role in
engaging stakeholders to build confidence and trust so as to collaborate in addressing the
challenges and failures occurring in the national pharmaceutical supply chain system. Talib
and Hamid (2014, p. 25) posit that relationships built on trust result in benefits to all supply
chain partners. Further, it is suggested that improving the security of health commodities,
rather than merely increasing financial resources for the procurement of drugs, could ensure
that medicines are available throughout the Malawi pharmaceutical supply chain. This is
because increasing the drug budget without improving commodity security would only
increase the medicines available to be pilfered.
Major findings on critical success factors in the procurement of essential medicines. An
efficient procurement system, availability of financial resources, knowledge and skills of
procurement staff, governance and accountability systems, capacity of suppliers and
collaboration and co-ordination of stakeholders are CSFs in the public health-care service
delivery system.
This is in line with the literature, which states that public sector organisations acquire
goods and services from suppliers, subject to the general principles of fairness, equitability,
transparency, competitiveness and cost-effectiveness. Public procurement is governed by
procurement laws and regulations and includes all the processes related to the sourcing of
goods and services by government departments, parastatals and local authorities (Ambe
and Badenhorst-Weiss, 2012, p. 244; Dzuke and Naude, 2017, p. 2; Seiter, 2010, p. 45).
 It is suggested that a robust procurement system and strategies be introduced. This Supply chain
would include, for instance, prequalification, indefinite quantity agreements and framework management
agreements with suppliers, in accordance with the Malawi Public Procurement Law.
In addition, organisations that successfully manage their supply chains increasingly
build the capabilities of their own employees as well as those of their partners. Training of
supply chain partners’ employees, also known as collaborative education, can result in more
successful supply chains and higher partner returns (Gibson et al., 2016, p. 477). Since the
procurement section is an important focal point in the supply chain management of essential
medicines, a robust team of procurement specialists is vital. These specialists would not
only offer evidence-based guidance to top management, but they would also help to interpret
the laws and implement the appropriate policy mechanism.
Major findings on critical success factors in warehousing and distribution of essential
medicines. Adequacy of storage space (be it rented or owned), the appropriateness of the
warehouse inventory management system and the skills and experience of warehousing
staff are critical for excellence in managing the supply chain of essential medicines in public
health-care service delivery. Likewise, an efficient and well-secured distribution system, use
of information technology to track distribution vehicles and support and commitment from
management also significantly contribute to the successful management of essential
medicines supply chain in the public health-care service.
The performance of the supply chain could be improved through continuously
developing the capacity of the staff who manage the stocks of essential medicines in the
warehouses (Parmar and Shah, 2016, p. 37). Such capacity building programmes would
result in staff acquiring appropriate skills to properly manage inventories of essential
medicines.
To access health facilities that are connected by poor road networks, it would be
worthwhile to invest in appropriate types of vehicles and collaborate with other transport
service providers who can provide vehicles that can get to hard-to-reach, mostly rural,
health facilities.

Conclusion
The purpose of this article was to analyse the CSFs that affect the supply chain management
in the delivery of public health-care services in Malawi, and the extent to which these factors
occur. This was achieved through a mixed research method approach by means of semi-
structured interviews with 12 participants and a questionnaire administered to 31
respondents, who are suppliers of essential medicines, regulators, donors and logistics
companies in Malawi. The qualitative data was analysed using thematic analysis and the
quantitative data analysed using SPSS version 22.0.
The findings confirmed that the identified CSFs are significant. In addition, their absence
is a significant barrier to the attainment of excellence in the supply chain management of
essential medicines in the public health-care service delivery system in Malawi.
The study had a number of limitations. First, although every effort was made to carefully
and purposefully select the participants for the in-depth interviews and the respondents for
the questionnaire, they were not randomly selected. Thus, the findings cannot be
generalised to all stakeholders in the pharmaceutical supply chain in Malawi. However, they
can be used as a basis for further research on the topic. Second, the CSFs were identified
from the literature review and a preliminary study. The implication of this is that the list of
CSFs is not exhaustive.
Three areas for further research are suggested. First, as it was suggested in this study
that the capacity of the staff should continually be developed to address supply chain
JGOSS capacity gaps, further research could include an analysis of the specific supply chain
management capacity gaps in human resources in the public health sector in Malawi.
Second, while it is acknowledged that medicines are lost, the actual quantity lost remains
unknown. Hence, there is an opportunity to conduct research to determine the real cost of
drug pilferage in the Malawi health-care system, both socially and economically. Third,
stakeholder collaboration and coordination is paramount in the public pharmaceutical
supply chain. Poor or little collaboration between supply chain partners results in
uncoordinated implementation of the forecasted demand and leads to overstocking or stock-
outs at facility level. However, whether there is collaboration or not, forecasting will
continue. Thus, a study could be undertaken to assess stakeholders’ contribution to the
availability of essential medicines in Malawi public health-care sector.
The value and originality of the study and, therefore, its expected contribution to the body of
knowledge, lies in the identification of the CSFs that matter most in the pharmaceutical supply
chain in Malawi. The study can assist stakeholders in the public health-care service delivery
system in developing countries to improve the supply of essential medicines. For academics, this
study provides a platform for future research on supply chain management CSFs, and the results
could aid researchers in developing the research instrument.
To conclude, the research findings support the narrative that CSFs can create
vulnerability in the supply chain in that, should CSFs not be continually reviewed, these
may present as a risk.

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About the authors Supply chain
Dr Feston Kaupa has over 25 years of professional experience in Finance and Strategic Business management
Management in both the private and public sectors, seven of which have been in Supply Chain
Management of Health Commodities. He holds bachelor’s degree in Accountancy from the University
of Malawi – The Polytechnic, mastera’s degree in Strategic Management from the University of
Derby, UK and master’s degree in Procurement, Logistics and Supply Chain Management from the
University of Salford, UK. He is a Chartered Global Management Accountant (CGMA), a Fellow of the
Chartered Institute of Management Accountants (FCMA) and also a Fellow of the Association of
Chartered Certified Accountants (FCCA). Feston has just completed PhD in Supply Chain
Management with the University of KwaZulu-Natal, South Africa. Feston is also a member of the
Institute of Chartered Accountants in Malawi (ICAM), Malawi Institute of Procurement and Supply
(MIPS).
Professor Micheline Juliana Naude is an Academic in the School of MIG at the University of
KwaZulu-Natal. Her area of expertise is in Supply Chain Management (undergraduate, honours,
masters and PhD level) in the areas of purchasing, operations and logistics management. She is an
NRF rated researcher having published articles in journals and presented papers on purchasing and
supply chain management, locally and abroad. She serves on the editorial board of the Journal of
Contemporary Management and the Journal of Transport and Supply Chain Management. She has co-
authored two books in supply chain management and purchasing and supply management. She
serves on the peer review panel of the Academic of Science of South Africa (ASSAF) to evaluate
scholarly journals in the Economics and Business Management disciplinary group. She is also a
member and Chair of the Educational Programmes Committee for the African Institute of Supply
Chain Research (AISCR). Micheline Juliana Naude is the corresponding author and can be contacted
at: NaudeM@ukzn.ac.za

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