Human Resource Capacity and Drug Supply Chain Performance in Urban Public Health Facilities: A Convergent Mixed-Methods Study of KCCA Tier III Facilities in Uganda

Abstract

In many public health facilities across Uganda, the absence of essential medicines is not simply a logistical inconvenience but a recurring reality that directly shapes patient outcomes, undermines confidence in health systems, and places additional strain on already overburdened health workers. In rapidly urbanizing settings such as Kampala, this challenge is further intensified by rising service demand, complex patient needs, and increasing pressure on limited health system resources. While previous reforms have predominantly focused on strengthening logistics systems, financing frameworks, and infrastructure, a critical yet often underexplored dimension remains the role of human resource capacity in determining supply chain performance.

This study examined the influence of human resource capacity on drug supply chain performance within Kampala Capital City Authority Tier III health facilities. A convergent mixed-methods design was employed, integrating quantitative data from 70 health workers with qualitative insights from six key informants directly involved in pharmaceutical and supply chain management. Although the response rate of seventy percent is methodologically acceptable, careful consideration was given to the potential effects of non-response bias, particularly given that staff experiencing higher workload pressures or lower technical capacity may have been underrepresented. To enhance the robustness of the findings, subjective perceptions were triangulated with objective indicators, including stock-out frequency, inventory accuracy, reporting timeliness, and order fulfillment rates.

The findings reveal a complex but consistent pattern. While many health workers perceive themselves as technically competent, these competencies are largely acquired through experiential learning rather than structured institutional training systems. This lack of formalization contributes to variability in practice and limits standardization across facilities. Persistent gaps in continuous professional development, coupled with significant staffing constraints, were identified as central factors affecting the efficiency and reliability of supply chain operations. Facilities with relatively stronger human resource capacity demonstrated more stable performance, reflected in improved reporting consistency, reduced stock disruptions, and enhanced inventory management. Statistical analysis indicated a moderately strong positive association between human resource capacity and supply chain performance. However, this relationship is interpreted cautiously as associative rather than causal due to the cross-sectional nature of the study.

The study contributes to the growing discourse on health systems strengthening by demonstrating that human resource capacity is not merely a supportive component but a central determinant of supply chain effectiveness. It underscores the need for deliberate and sustained investment in structured training systems, workforce optimization, and supportive supervision mechanisms. Strengthening these human resource dimensions is essential for enhancing the resilience, responsiveness, and overall performance of urban public health supply chains.