Practice and challenges of humanitarian logistics management within the Ethiopian public pharmaceutical supply chain

Abstract

Background

Humanitarian logistics involves the coordinated movement of relief goods, personnel, information, and funds between beneficiaries, donors, and suppliers, which is crucial for successful emergency response operations. In Ethiopia, logistical challenges often hinder access to healthcare services. This study focuses on humanitarian logistics management (HLM) in Ethiopia, aiming to assess the perceptions of HLM practices, identify key challenges, and provide solutions to improve healthcare access for beneficiaries.

Methods

An explanatory and descriptive case study design was used to explore the logistical challenges. A mixed-methods approach, combining both quantitative and qualitative data, was employed concurrently. The study surveyed 92 professionals in technical and managerial positions from nine directorates involved in core humanitarian logistics activities, using a census sampling method.

Results

The study identified 20 key challenges, grouped into five categories. Organizational and economic challenges were the most prominent. The findings revealed notable variations in HLM practices across organizations. Inventory management was the most commonly implemented logistics function, followed by distribution management. In contrast, procurement and transportation management were less effectively practiced. Among the organizations studied, the Ethiopian Public Health Institute demonstrated more effective HLM practices compared to the Ministry of Health and the Ethiopian Pharmaceuticals Supply Service.

Conclusions

The study highlights significant inefficiencies in the humanitarian logistics system, particularly in procurement and transportation management. These inefficiencies disrupt humanitarian operations, leading to delays in the delivery of pharmaceuticals to beneficiaries. Inadequate logistics can result in loss of life, increased suffering, and unnecessary costs. This research contributes to understanding the gaps in HLM practices in Ethiopia and provides recommendations for improving logistics efficiency in public health emergencies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-13279-3.

Introduction

Background of the study

Access to medicines during disasters is a fundamental human right, yet barriers such as insecurity, logistical constraints, and lack of infrastructure often hinder this access, leading to significant health consequences [1–3]. Public health emergencies and natural disasters disrupt healthcare services and have profound socio-economic impacts. Between 2001 and 2021, global disasters resulted in nearly 1.5 million deaths and caused US$ 4.1 billion in economic damage [4]. In Africa, including Ethiopia, the frequency and impact of such disasters have increased in recent years. As one of the most disaster-affected countries, Ethiopia has faced multiple natural and man-made crises, exacerbating the humanitarian situation [5].

This study aims to evaluate the humanitarian logistics challenges in Ethiopia, particularly in healthcare delivery during disasters. The focus is to assess how logistical inefficiencies, infrastructure limitations, and coordination issues hinder the timely delivery of essential medicines and healthcare services. Additionally, the study aims to explore methods for improving the resilience and efficiency of logistics systems in response to public health emergencies and natural disasters.

Humanitarian logistics refers to the process of managing and coordinating the movement of goods, resources, and information to ensure timely assistance reaches those affected by crises [6]. Effective humanitarian logistics plays a crucial role in disaster response, particularly in providing healthcare services during emergencies [7]. However, the unique challenges faced in humanitarian logistics, including limited funding, unreliable infrastructure, and coordination complexities, necessitate dedicated study to improve system efficiencies and outcomes [8].

This paper uses a mixed-methods approach to explore the humanitarian logistics challenges in Ethiopia. The primary methods include qualitative interviews with key stakeholders from humanitarian organizations, analysis of logistical performance data, and a case study of previous disaster response operations. The study aims to provide actionable insights for improving logistics systems and healthcare delivery in future crises.

Literature review

Overview of humanitarian logistics

Humanitarian logistics plays a pivotal role in ensuring the timely and efficient distribution of resources during crises. It differs significantly from commercial logistics due to its non-profit nature, complex organizational structures, and the urgency of operations [6]. Logistics challenges in disaster management are often compounded by the unpredictability of demand, inadequate infrastructure, and fluctuating supply chain conditions [7, 8].

Challenges in humanitarian logistics

Humanitarian logistics faces several well-documented challenges that can impede effective disaster response. One significant issue is coordination. Disjointed coordination between donors, governments, and humanitarian organizations often leads to inefficiencies and the duplication of efforts. In the context of Ethiopia, this challenge is further compounded by weak institutional frameworks and a lack of clearly defined roles among the various actors in the logistics chain [9]. These coordination gaps result in delays and the misallocation of resources, undermining the overall efficiency of the response effort.

Another critical challenge is infrastructure deficiencies. Poor or damaged infrastructure, such as roads and warehouses, can cause significant delays in the delivery of essential supplies, particularly in remote areas. In Ethiopia, the country’s underdeveloped infrastructure exacerbates the difficulty of reaching affected populations promptly [10]. Without reliable transportation and storage systems, relief efforts are severely hampered.

Financial constraints also play a major role in limiting the effectiveness of humanitarian logistics operations. Funding shortfalls are common in disaster response, restricting the availability of resources needed for rapid and efficient service delivery. In Ethiopia, the increasing frequency of natural disasters places additional pressure on already stretched resources, making it more difficult to maintain consistent logistical operations [11].

Furthermore, staffing and training pose significant challenges. Humanitarian logistics often suffers from high turnover rates and a lack of formal training for logistics personnel, which undermines the efficiency of operations. Inadequate training and a shortage of skilled workers contribute to mismanagement and delays, particularly in disaster-stricken areas where speed is crucial [8, 12].

Supply chain challenges and humanitarian logistics

Humanitarian logistics shares several common challenges with commercial supply chains, particularly in managing inventory, ensuring timely deliveries, and balancing supply and demand uncertainties [13]. However, the complexity of humanitarian logistics is heightened by the need for rapid response, geographical and political constraints, and the involvement of multiple stakeholders. These factors make it more difficult to ensure that resources reach their destination on time and in adequate quantities.

The pharmaceutical supply chain within the humanitarian logistics framework also faces unique challenges. These include issues with stockpiling, the cold chain requirements for certain medicines, and the need for regulatory compliance during emergencies. The importance of ensuring that medicines are not only available but also stored and transported under the appropriate conditions becomes more pronounced during disaster scenarios [14]. These logistical concerns are particularly relevant in the healthcare supply chain, where timely delivery of medicines can be a matter of life and death.

Performance drivers in humanitarian logistics

Performance in humanitarian logistics is driven by several key factors, each contributing to the overall efficiency and effectiveness of operations. One critical factor is response time. In disaster situations, the ability to deliver goods quickly is paramount, as delays can reduce the effectiveness of humanitarian assistance and increase the risk of further harm to affected populations [7, 8]. Rapid response requires not only an efficient supply chain but also a high level of coordination and readiness.

Coordination and collaboration are also essential for successful logistics operations. Effective coordination among multiple organizations, governments, and private sector partners ensures that resources are allocated properly and that there is no duplication of efforts [12]. This is particularly important in large-scale disasters where multiple humanitarian actors are involved, and clear communication is crucial for optimal resource management.

The role of technology is increasingly significant in improving the visibility and decision-making capabilities of humanitarian logistics systems. The integration of information technology (IT) systems, such as real-time tracking and inventory management tools, enhances logistical efficiency by providing accurate and timely information. However, the adoption of such technologies remains limited, especially in developing countries like Ethiopia, where technical infrastructure may be insufficient [6, 8].

Lastly, infrastructure resilience is a critical performance driver in humanitarian logistics. The capacity of local infrastructure to withstand and recover from disasters directly influences the speed and effectiveness of aid delivery. Well-maintained infrastructure can significantly reduce delays and improve response efforts, while poor infrastructure creates bottlenecks and complicates the logistics process [15, 16].

Linking humanitarian logistics with supply chain management

The work of Chopra, S., Meindl, P., (2007) on supply chain management emphasizes the importance of strategic alignment, risk management, and demand forecasting for effective logistics operations [13]. These principles are highly applicable to humanitarian logistics, where managing uncertainty, optimizing resource allocation, and ensuring supply chain resilience are essential for success. In humanitarian settings, the unpredictability of demand and the challenges of resource scarcity make these supply chain management principles particularly relevant.

The “push strategy” is one approach often used in humanitarian logistics, where aid is pre-positioned in certain locations and distributed based on assessments of need [7]. This strategy has proven effective in some cases but requires further empirical support, particularly in the context of Ethiopia. In regions with infrastructural and coordination challenges, alternative strategies may be more suitable to ensure the efficient distribution of aid. A push strategy in humanitarian logistics is often employed to distribute goods based on anticipated needs rather than actual demand [17]. However, this strategy has been critiqued for leading to inefficiencies, particularly in developing countries.

Humanitarian logistics in the Ethiopian context

Ethiopia faces unique logistical challenges in humanitarian response due to frequent conflicts, environmental shocks, and a history of underdeveloped infrastructure. The Ethiopian healthcare system is particularly vulnerable to these challenges, struggling with weak procurement systems, poor stockpile management, and a lack of coordination among various actors involved in the logistics process [9, 11]. These systemic issues are compounded by political instability, which further limits the effectiveness of disaster response efforts. As a result, Ethiopia’s capacity to provide timely and efficient healthcare during disasters is significantly impaired, making it essential to explore strategies for improving logistical operations in the country [18].

Methods

Study area, design, and period

This study employed an analytical cross-sectional design, complemented by qualitative assessments through in-depth interviews (IDI) and surveys. Data collection occurred from September 10, 2021, to October 9, 2021, at the headquarters of the Ministry of Health (MOH), the Ethiopian Pharmaceutical Supply Service (EPSS), and the Ethiopian Public Health Institute (EPHI) in Addis Ababa, Ethiopia. These institutions were chosen due to their central role in managing and coordinating humanitarian logistics, healthcare services, and public health responses in Ethiopia [7]. The study period, identified based on the availability of key informants and logistical resources, was deemed appropriate to capture timely insights into humanitarian logistics practices and challenges.

Source of data

For the quantitative aspect, primary data were gathered via a structured survey designed to assess the perceptions and challenges of humanitarian logistics management [7, 8]. The qualitative data were collected through key informant interviews (KIIs), offering deeper insights into the operational challenges faced by personnel working in humanitarian logistics. The combination of both qualitative and quantitative data allowed for a comprehensive understanding of the humanitarian logistics landscape, as suggested by Miles and Hubermann (1994) in their mixed-methods research approach [19].

Study population and sample design

The target population for this study consisted of employees from the MOH, EPSS, and EPHI, located at their respective headquarters in Addis Ababa. Respondents were selected from a range of departments, including those involved in forecasting, market shaping, pharmaceutical management, warehouse and inventory management, contract and tender management, medical services, distribution, fleet management, and public health emergency management logistics. This broad inclusion allowed for capturing diverse perspectives on the humanitarian logistics system, including those from both operational and strategic levels of the organizations [8].

The sampling strategy used in this study was non-probabilistic purposive sampling, as it specifically targeted professionals working in humanitarian logistics roles within the MOH, EPSS, and EPHI. This approach was appropriate because the study sought to understand the perspectives of individuals with relevant expertise and experience in humanitarian logistics management [20]. Given the limited number of professionals in these roles, all available staff members (92 professionals in total) from the targeted institutions were included in the study. This sampling strategy led to an overrepresentation of individuals from EPSS, where a larger proportion of personnel were involved in humanitarian logistics compared to the MOH and EPHI. This overrepresentation was justified due to the role of EPSS in the central supply chain management of pharmaceutical products in Ethiopia [8].

The study’s sampling was disproportionate, as the sample sizes from the MOH, EPHI, and EPSS were not proportionate to the total number of employees in each institution. However, this was a deliberate choice to ensure that the perspectives from EPSS, which plays a central role in humanitarian logistics, were sufficiently captured [21].

Methods of data collection and management

For the quantitative component, a semi-structured questionnaire was developed after reviewing existing literature on humanitarian logistics management [7, 8]. The questionnaire consisted of three sections: Socio-demographic information (8 questions), Perceived practices of humanitarian logistics (26 questions) and Perceived challenges in humanitarian logistics (20 questions). These sections used a 5-point Likert scale (strongly disagree to strongly agree).

For the qualitative component, a detailed interview guide was developed in English and then translated into Amharic, the local language. The interview guide included open-ended questions designed to capture key informants’ experiences with the practices and challenges in humanitarian logistics management. The qualitative data collected via interviews provided rich, narrative insights into the operational realities and contextual challenges faced by key stakeholders, as described in the methodological approaches of Miles and Hubermann (1994) [19].

Data collection occurred in two phases: quantitative data were gathered through self-administered surveys, with most responses collected on the same day. Qualitative data were collected through face-to-face interviews, which were conducted in private office settings to ensure confidentiality [20]. Informed consent was obtained from all participants before data collection, and audio recordings of the interviews were made with the participants’ consent. Interviews were conducted primarily in Amharic to ensure that participants were comfortable and could fully express their views. The Principal Investigator (PI), supported by three trained data collectors, oversaw the data collection process. The PI conducted the interviews, which typically lasted about 30 min each.

Data quality assurance

The data collection instruments were pretested on 5% of the staff from the EPSS Addis Ababa Hub and the Addis Ababa Health Bureau. This pretest was essential to assess the clarity and relevance of the questions [8]. The reliability of the quantitative data collection instrument was assessed by calculating Cronbach’s alpha coefficient, which resulted in a value of 0.945, indicating excellent internal consistency [22]. Regular supervision was provided by the research advisor, who also verified the accuracy of qualitative data transcription and translation. A senior researcher from the University of Gondar validated the instrument in reviewing the data collection instrument, transcription and interpretation process [20].

Methods of data analysis

Quantitative data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 26. Descriptive statistics (e.g., frequency, mean, percentages) and inferential statistics (e.g., sequential linear regression, Kendall’s W coefficient of concordance) were applied. Prior to conducting regression and rank order analysis, checks for normality, linearity, and multicollinearity were performed. The normality of the data was assessed through skewness and kurtosis, and outliers were detected using Field, A. (2013) distance at p < 0.001 [23]. Statistical significance was set at a 95% confidence interval (CI) with a p-value of less than 0.05.

The qualitative data were analyzed using thematic analysis, guided by the coding methods suggested by Miles and Hubermann (1994) [19]. The interview recordings were transcribed verbatim and translated into English. Themes were identified through the process of open coding, where variables were initially grouped into categories based on recurring patterns [19]. After coding, similar codes were clustered into themes that reflected the main challenges and practices identified by the participants. The analysis involved multiple stages, beginning with a preliminary reading of the transcripts to identify broad themes, followed by more detailed coding to refine these themes. The researchers independently reviewed the codes and themes to ensure reliability and consistency in the data analysis process (Table 1).

Table 1.

Key informants, roles, and backgrounds

Name/ID	Organization
Key Informant1	Ministry of Health (MOH)
Key Informant 2	Ethiopian Pharmaceutical Supply Service (EPSS)
Key Informant 3	Ethiopian Public Health Institute (EPHI)
Key Informant 4	EPSS
Key Informant 5	MOH
Key Informant 6	EPSS
Key Informant 7	EPHI

The integration of quantitative and qualitative data followed a convergent design, where both types of data were collected concurrently but analyzed separately. The findings from both datasets were then compared and integrated to draw comprehensive conclusions about the practices, challenges, and opportunities in humanitarian logistics management [20].

While the study was initially conceptualized in 2021, the methodology evolved over time to address emerging challenges and logistical constraints. The timeline was adjusted to align with the availability of key informants and to allow for a more comprehensive review of the humanitarian logistics system in Ethiopia, taking into account recent developments in the country’s public health and disaster response mechanisms [11]. The timing of the study was crucial for capturing current practices and challenges, particularly in light of the growing frequency of natural disasters and health emergencies in Ethiopia [18].

Results

Demographic profile of the respondents

The demographic profile of the respondents is highly relevant to the study’s focus on humanitarian logistics in Ethiopia, particularly in the healthcare sector. The predominance of respondents with a background in pharmacy (50%) and supply chain management (17.4%) aligns well with the study’s aim to assess the practices and challenges of humanitarian logistics, as these fields are critical to understanding logistics operations in healthcare settings. The seniority of most participants (76.1% senior officers) ensures that the insights gathered reflect the experience and expertise of key decision-makers involved in humanitarian logistics management.

Furthermore, the age group of 26–35 years (56.5%) suggests that the respondents are likely to be actively engaged in the current practices and challenges of logistics operations, making their perspectives particularly valuable for informing improvements in the sector. Additionally, the high number of respondents from the Ethiopian Pharmaceutical Supply Service (EPSS) (72.8%) reflects the organization’s central role in managing medical supply chains in Ethiopia, further strengthening the study’s focus on health supply chains and logistics (Table 2).

Table 2.

Demographic and professional characteristics of the study participants (n = 92)

Variable	Category	n (%)
Sex	Male	74 (80.4)
	Female	18 (19.6)
Educational Level	First degree	50 (54.3)
	Master	42 (45.7)
Age Range	18–25	9 (9.8)
	26–35	52 (56.5)
	36–45	26 (28.3)
	≥ 46	5 (5.4)
Area of Specialization	Logistics and Supply Chain Management	16 (17.4)
	Master of Business Administration	9 (9.8)
	Pharmacy	46 (50.0)
	Pharmaceutical Supply Chain Management	3 (3.3)
	Others1	18 (19.6)
Place of Work	EPSS	67 (72.8)
	MOH	20 (21.7)
	EPHI	5 (5.4)
Directorates or Teams	Forecasting and Market Shaping	14 (15.2)
	Pharmaceuticals & Medical Devices Management	13 (14.1)
	Warehouse and Inventory Management	33 (35.9)
	Contract and Tender Management	21 (22.8)
	Others2	11 (12.0)
Current Position in Directorate or Team	Coordinator or Team Leader	15 (16.3)
	Director or Deputy Director	7 (7.6)
	Senior Officer	70 (76.1)
Work Experience	1–5 years	39 (42.4)
	6–10 years	45 (48.9)
	≥ 10 years	8 (8.7)

¹The category includes biomedical, health supply chain management, nutrition, public management, project management, public health, and medical doctor

²The category involves Medical Services General Directorate, Distribution and Fleet Management, cross cutting

Practices of humanitarian logistics of public health emergency pharmaceuticals

The study on humanitarian logistics management practices at PHE Pharmaceuticals reveals a complex landscape of strengths and weaknesses across various logistics functions (Table 3).

Table 3.

Respondents’ perceptions of the humanitarian logistics practices of PHE pharmaceuticals in the MOH, EPSS and EPHI (n = 92)

Humanitarian Logistics Management Practices of PHE Pharmaceuticals		Mean (± SD)
Procurement management practice	My organization has built procurement strategy based on a preliminary need assessment	1.96(0.74)
	My organization has systems to quantify public health emergency pharmaceuticals	1.80(0.71)
	My organization considers a number of procurement options	1.87(0.71)
	Purchase orders placed and delivered on time and at a reasonable price in my organization	2.00(0.83)
	My organization appropriately manages in-kind donations and procured Pharmaceutical	2.10(0.87)
	My organization manage contracts and resolve challenges	4.11(0.75)
	Mean of procurement management practice	2.31
Distribution management practice	My organization distribution hubs are well established to save operating costs	3.84(1.18)
	There exists an effective distribution management tool in my organization	3.84(1.19)
	There exists a timely distribution of pharmaceuticals in my organization	3.83(1.05)
	My organization distribution plans considers both demand and available stock	3.86(1.12)
	Central distribution facilities are used for the distribution in my organization	3.78(1.10)
	Mean of distribution management practice	3.83
Warehouse management practice	There exist a sufficient and proper warehouse for temporary storage in my organization	3.86(0.94)
	Regular warehouse floor optimization and standardization is conducted in my organization	3.30(1.26)
	My organization warehouse is suitable for order processing	3.04(1.32)
	My organization warehouse strictly adheres to good pharmaceutical storage procedures	3.30(1.16)
	Tracking and tracing systems are used at the warehouse in my organization	3.25(1.20)
	Mean of warehouse management practice	3.35
Inventory management practice	There exist prepositioning and optimal resource allocation in my organization	4.13(0.68)
	There is a practical supply and demand evaluation in my organization	4.26(0.69)
	There exists optimization of inventory turnover in my organization	4.09(0.77)
	There exists first-expire-first-out inventory management system in my organization	4.08(0.68)
	There exists reservation of a safety stock of pharmaceuticals in my organization	3.96(0.77)
	Mean of inventory management practice	4.10
Transportation management practice	My organization considers the urgency of the demand in selection of mode of transportation	1.96(0.74)
	Pharmaceuticals transported to where they are needed rapidly in my organization	1.80(0.71)
	There exists partnership with 3rd party transportation organizations in my organization	1.87(0.71)
	Multiple transportation optimization techniques employed to reduce cost in my organization	2.00(0.83)
	Vehicles employed depending on the nature of pharmaceuticals in my organization	2.10(0.87)
	Mean of transportation management practice	1.95
Mean of Humanitarian Logistics Management Practices of PHE Pharmaceuticals		3.11

In Procurement Management, the survey highlighted that practices like developing procurement strategies (mean = 1.96) and systems for supply chain planning activities (mean = 1.80) are poorly implemented. However, Contract Management is notably stronger (mean = 4.11). The poor practices in procurement are consistent across organizations, including the Ministry of Health (MOH), Ethiopian Pharmaceutical Supply Service (EPSS), and the Ethiopian Public Health Institute (EPHI), where the mean scores ranged between 2.28 and 2.38. The qualitative responses echoed these findings, emphasizing issues like inadequate budget allocation and delays in procurement processes, such as port clearance, warehouse costs, and the failure to meet delivery schedules as agreed between organizations. As one key informant noted, “My organization has a practice of identifying the needs of pharmaceuticals based on the joint Emergency Preparedness and Response Plan (EPRP). However, the procurement and stockpiling of quantified pharmaceuticals are unsatisfactory due to inadequate budget allocation and poor resource mobilization activities. Despite the payment effected by both the MOH and EPHI, the EPSS is unable to procure and deliver pharmaceuticals on time as per the agreement between the organizations. Donation management at the MOH, EPSS, and EPHI is not effective. A delay in port clearance and payment of unnecessary demurrage and warehouse costs are common” (KI 1).

In Distribution Management, respondents felt that the use of central distribution networks (mean = 3.78) and the suitability of delivery sites to save costs (mean = 3.84) are practiced to a higher degree. The MOH, EPSS, and EPHI all reflected solid practices in this area, with mean scores between 3.77 and 4.44. However, key informants pointed out that distribution performance is inconsistent, with delivery schedules and timeliness often falling short, despite occasional successes. One respondent shared, “There are situations where distributions had been managed well, but this is very occasional experience. All in all, the distribution management system is below average considering delivery schedule, timeliness, and absence of incomplete/partial delivery…” (KI 2).

For Warehouse Management, respondents considered the maintenance of adequate and suitable warehouses (mean = 3.86) a highly practiced activity, although practices like order processing appropriateness (mean = 3.04) and good storage principles (mean = 3.30) were seen as moderate. The overall warehouse management score was 3.35, indicating room for improvement. Informants noted that while the EPSS has made efforts to dedicate distinct warehouses for emergency operations, challenges remain in ensuring consistency and adequacy in storage for timely deliveries. One respondent noted, “The EPSS attempts to dedicate a distinct warehouse for emergency response operations. This enabled the organization to deliver the supplies required at the right time and quantity” (KI 3).

Regarding Inventory Management, practices like realistic supply and demand evaluation (mean = 4.26), effective resource allocation (mean = 4.13), and FIFO (First-In-First-Out) inventory management (mean = 4.08) were seen as highly practiced. These practices were particularly strong at the MOH (mean = 4.20), suggesting a well-organized approach to managing pharmaceutical inventories in these areas.

Lastly, in Transport Management, practices were notably weak. The transportation mode selection based on urgency (mean = 1.96) and the timeliness of deliveries (mean = 1.80) were both poorly practiced. The overall mean score of 1.95 for transportation management reflects significant issues in this area, with respondents highlighting challenges like poor infrastructure and logistical bottlenecks. One informant shared, “The organization attempts to deliver the supplies required at the right time and quantity. However, transportation problems coupled with infrastructural conditions make it challenging to deliver relief items on time. More emphasis should be given to strengthening transportation practices to provide pharmaceuticals in a timely manner to minimize the response rate. Outsourcing fleet management may be helpful in such conditions” (KI 1).

Therefore, while there are some strong practices in areas like warehouse and inventory management, many key logistics functions, especially procurement and transportation, suffer from poor implementation.

Differences in respondents’ perception of humanitarian logistics management practices of PHE pharmaceuticals

The differences in respondents’ perception of humanitarian logistics management practices across the three organizations—MOH, EPSS, and EPHI—were noteworthy. The findings indicate varying levels of practice, with the MOH and EPSS showing moderate practices, while the EPHI demonstrated higher levels of practice across the board. In particular, warehouse management and overall humanitarian logistics management practices displayed significant differences. Specifically, the MOH and EPSS had moderate mean scores of 3.08 (SD = 0.51) and 3.09 (SD = 0.66), respectively. In contrast, the EPHI recorded a higher mean score of 3.49 (SD = 0.29), reflecting more extensive practices in these areas.

The results of the one-way ANOVA test indicated a statistically significant difference among the group mean scores, particularly for warehouse management and overall humanitarian logistics management practices (P value < 0.034). This suggests that the EPHI outperforms the MOH and EPSS in the effective implementation of these logistics’ functions, as evidenced by the higher mean scores observed at the EPHI. This disparity highlights the need for further investigation into the factors that contribute to the higher levels of practice at EPHI, including organizational structures, resource availability, and strategic planning, which may help improve the logistics practices at the MOH and EPSS (Table 4).

Table 4.

Differences in respondents’ perceptions of practices of humanitarian logistics management of PHE pharmaceuticals in MOH and EPSS

Variable	N	Mean (± SD)	F-score	p-Value
Procurement Management	MOH(n = 20) EPSS(n = 67) EPHI(n = 5)	2.38(0.29) 2.28(0.39) 2.30(0.14)	0.584	0.560
Distribution Management	MOH(n = 20) EPSS(n = 67) EPHI(n = 5)	3.87(0.69) 3.77(1.00) 4.44(0.59)	1.238	0.295
Warehouse Management	MOH(n = 20) EPSS(n = 67) EPHI(n = 5)	2.92(0.67) 3.77(0.84) 4.48(0.18)	12.440	0.000
Inventory Management	MOH(n = 20) EPSS(n = 67) EPHI(n = 5)	4.20(0.56) 4.09(0.65) 4.10(0.38)	0.694	0.502
Transportation Management	MOH(n = 20) EPSS(n = 67) EPHI(n = 5)	2.10(0.33) 1.92(0.41) 2.00(0.14)	0.439	0.646
Humanitarian Logistics management Practices	MOH(n = 20) EPSS(n = 67) EPHI(n = 5)	3.08(0.51) 3.09(0.66) 3.49(0.29)	3.502	0.034

Challenges of humanitarian logistics management practice of PHE pharmaceuticals

In this study, twenty challenges were categorized into five categories; each category was represented by four questions. The respondents rated challenges by their frequency of occurrence, which hindered effective logistics management practices. Generally, all the challenges affected the practice influentially, with organizational challenges taking the first position by level of occurrence, followed by (3.86, ±SD = 0.62) economic (3.78, ±SD = 0.84) and technical challenges (3.70, ±SD = 0.83).

Among these twenty challenges, lack of competent local transportation service providers (mean rank = 8.66), unsuitable topography (mean rank = 8.73), lack of partnership with 3rd party transportation organizations (mean rank = 8.78), high staff turnover (mean rank = 8.99) and uncertainty in demand and supply (mean rank = 9.08) are the top five and most frequently occurring challenges of logistics management practices. Based on the table below, we can conclude that the agreement or concordance among the respondents is not due to chance regarding the challenge of the humanitarian logistics management practices of PHE pharmaceuticals, as P < 0.00 with a W = 0.06 (Table 5).

Table 5.

Rank order analysis of challenges in the humanitarian logistics management practices of PHE pharmaceuticals in the MOH and EPSS (n = 92)

Challenges on humanitarian logistics management practices	Mean Rank	Rank
Lack of competent local transportation service providers	8.66	1
Unsuitable topography; facility location problem	8.73	2
Lack of partnership with 3rd party transportation organizations	8.78	3
High staff turnover among supply chain experts.	8.99	4
Uncertainty in demand and supply	9.08	5
Lack of concerns for warehouse infrastructure	9.52	6
Lack of competent local pharmaceutical manufacturer/suppliers	9.95	7
Limited investment in adoption of ICT solutions	10.17	8
Inability to make decisions rather, other program staffs	10.18	9
Lack of sufficient communications lines and infrastructures	10.32	10
Inadequate financing for logistic strategic preparedness	10.35	11
Low ICT utilization for supply chain efficiency improvement	10.79	12
Lack of capacity to use of the obtained fund right away.	10.80	13
Lack of adequate experience and familiarity	11.35	14
Limited access of essential logistics information between organizations	11.40	15
Role confusion between organizations	11.60	16
Lack of joint logistics set up & implementation to reduce the lead time	12.18	17
Cultural and linguistic barriers	12.26	18
Limited coordination	12.30	19
Uncompetitive of market behavior in the local economy	12.57	20
Kendall’s W = 0.060 Chi-Square =104.894 df = 19 Asymp. Sig. = 0.000

Qualitative findings on challenges in humanitarian logistics management practices of PHE pharmaceuticals

In examining the humanitarian logistics management practices of PHE pharmaceuticals, the qualitative data was selectively presented to focus on the key challenges identified by the respondents. This selective presentation was intentional and aimed at providing clear and actionable insights into the specific barriers hindering effective logistics management. The primary purpose was to highlight the most frequently occurring and significant challenges, including poor demand planning, limited coordination, financing issues, delays in customs clearance, and limitations in local manufacturing capacity. This focus ensured that the data remained concise and relevant, allowing for a more meaningful interpretation of the logistical difficulties faced by the organizations.

The rationale for this approach was to avoid overwhelming the reader with excessive details. While a wide array of challenges were identified, presenting only the key issues kept the narrative focused and manageable, ensuring that the most critical obstacles stood out. This approach also complemented the quantitative findings, which showed lower-rated practices in areas such as transportation management and procurement. By aligning the qualitative data with these findings, the study provided a more holistic understanding of the challenges in humanitarian logistics.

A total of 17 challenges were identified from the responses of seven key informants. The challenges were primarily categorized into environmental, organizational, and technical issues. The respondents indicated that various factors impede the smooth execution of humanitarian operations at the MOH, EPSS, and EPHI, hindering effective and efficient logistics management. Below, the challenges are elaborated in greater detail:

Challenges related to demand planning

A recurring challenge discussed by respondents was the lack of collaboration between the MOH, EPSS, and EPHI in developing a comprehensive list of essential public health emergency management pharmaceuticals. While these organizations theoretically forecast a three-month supply of necessary pharmaceuticals and update the list quarterly in response to potential public health emergencies, logistical constraints such as limited supply planning, financial mismatches, and inadequate data quality prevent these goals from being fully realized. The respondents noted that achieving national emergency stockpile targets was difficult, with only half of the required stockpiles being met.

One respondent explained: “The practice of demand planning and stockpiling activity is at its infancy and needs a revolution to make it come to the real ground at the national level.” (KI 1).

Another respondent elaborated further: “The professionals assigned to the position do not have enough knowledge about advanced demand planning and inventory optimization. For example, they do not have adequate knowledge, skills, or tools to predict future demand, differentiate outcomes, or conduct and follow up on supply planning based on output. It is obvious that the nation will suffer from logistics disruptions in managing pharmaceuticals, reducing the health outcomes of the patients.” (KI 4).

Limited coordination

Limited coordination was another significant challenge highlighted by respondents. The logistics process at the National Emergency Operation Center (EOC) typically involves a multidisciplinary team, including representatives from the EPSA, the Ethiopian Food and Drug Authority, and donor organizations. However, despite this, respondents emphasized that there is insufficient coordination between governmental and non-governmental organizations in the overall logistics operations.

One respondent pointed out: “The designed and deployed transitory supply chain management structure is not recognized as a core unit at the national level. The unit can’t attain a strategic management of public health emergency preparedness and responses through active information sharing and better multiagency coordination and collaboration unless there is a formal inclusion of logistics management in organizational structure.” (KI 5).

Another respondent commented on the duplication of efforts: “The coordination level between humanitarian organizations and governmental organizations is low, and each organization is delivering similar donations, which leads to a duplication of efforts. Some products are not even found in the national essential medicine list.” (KI 6).

Additional challenges were noted in the delays related to market authorization. One respondent highlighted: “Long market authorization poses a significant challenge in the utilization of innovative medicines to treat public health emergencies. For example, during the COVID-19 pandemic, several medicines received approval from the WHO; however, this has made it difficult to import and utilize them in our country. Such delays are the main source of illegal markets.” (KI 3).

Limited preparedness and financing

Respondents also identified issues related to preparedness and financing. While the government allocated funds for disaster preparedness and response, the budgets often fell short of covering all emergency needs. Additionally, respondents noted that limited public-private partnerships and shortages in foreign exchange further compounded the challenges in accessing essential medicines.

One respondent noted: “Usually, 10% of the annual Ministry budget was reserved for health-related unseen emergencies and would be used for disaster preparedness and response.” (KI 1).

Another respondent explained the financial and market-related challenges: “The global and local market shortcomings due to limited preparedness, low public–private partnerships, and shortage in foreign exchange pose a significant challenge in access to essential medicines. Therefore, legislation on the provision of duty-free import permits, foreign currency priority services, and local pharmaceutical manufacturing prepared and entered into force for the private sector (manufacturers, wholesalers, and nongovernmental health facilities), government health facilities, and NGOs importing both raw materials and finished goods for prevention and treatment.” (KI 7).

Poor customs clearance processes

A critical issue that emerged from the qualitative findings was poor customs clearance processes. Respondents pointed out that delays and issues in customs clearance at ports significantly hampered the timely delivery of pharmaceuticals, especially in emergency situations. These problems were often related to non-compliance with shipping documents, inadequate knowledge, and poor coordination between EPSS and EPHI.

One respondent shared: “The custom clearance process for donated commodities is hectic. Partial delivery of both shipping documents and parcels, lack of adequate knowledge, and poor coordination between the EPSS and EPHI. I can be a witness for spoilage of our consignment due to such kind of problems.” (KI 4).

Discussion

Humanitarian logistics management practices and challenges of PHE pharmaceuticals

The optimization of humanitarian logistics practices, particularly those related to procurement, distribution, and warehouse management, is central to enhancing the performance of supply chains in response to public health emergencies. The findings of this study emphasize both the progress and the substantial challenges faced by humanitarian organizations in these areas. This section explores these practices and challenges in more detail, supporting the discussion with both theoretical and practical perspectives.

Procurement practices in humanitarian logistics often face obstacles due to a lack of resources, insufficient local suppliers, and gaps in demand forecasting. This study’s finding that demand planning activities were poorly executed aligns with previous studies by [24] and [25], who found that demand planning was often reactive and not sufficiently aligned with actual needs in disaster situations [24, 25]. These issues lead to procurement delays, stockouts, and the inefficient use of resources [3].

In particular, the procurement strategy development and execution were identified as poorly practiced in the organizations surveyed. This issue is consistent with findings from [26], who also noted that procurement strategies in humanitarian supply chains were often ad hoc, relying heavily on donor funding, and prone to inefficiencies [26]. The absence of reliable demand planning tools further exacerbates these procurement inefficiencies, making it difficult to maintain an adequate supply of essential pharmaceuticals. In this context, forecasting models that integrate historical data, real-time information, and demand patterns are essential to improving procurement strategies [17].

Furthermore, procurement challenges are compounded by limited local manufacturing capacity and delays in customs clearance procedures, as discussed by [27] and [28] and [27, 28]. These factors delay the timely delivery of critical medical supplies, which is crucial in public health emergencies such as the ongoing COVID-19 pandemic or humanitarian crises in conflict zones [29].

While distribution practices were identified as moderately to highly practiced, the findings also highlighted the critical importance of infrastructure and coordination in ensuring efficient delivery. In alignment with previous research by [30] and [31], the distribution challenges in the studied organizations stemmed from inadequate road infrastructure, poor communication, and the lack of reliable local delivery networks [30, 31]. These issues resulted in delays in reaching affected populations in remote or conflict-affected areas.

Warehouse management was also found to be moderately practiced, contrary to the findings of [32], who noted more robust warehouse management practices in other humanitarian contexts [30, 32]. These moderate practices could reflect inconsistencies in the availability of storage facilities, inventory control systems, and trained personnel. As seen in the study by [33], post-disaster logistics operations often face resource constraints that limit warehouse operations, making it difficult to maintain efficient stockpiles of essential goods [33].

Additionally, the temperature-sensitive nature of many pharmaceutical supplies exacerbates the challenges related to warehouse management. Mishandling during storage, lack of temperature control, and stock rotation issues can compromise the quality of these critical supplies [7]. Inadequate warehouse conditions also increase the likelihood of wastage due to expiry or spoilage of medicines, as noted by [26].

This study identified social challenges as the most frequently reported obstacles in humanitarian logistics. These challenges are often linked to issues of coordination, inter-agency collaboration, and community engagement, and they significantly hinder the effectiveness of humanitarian supply chains. The findings of this study corroborate the research by [34] and [35] who emphasized that social and organizational factors are often the primary barriers to efficient logistics operations [34, 35]. Humanitarian organizations frequently face difficulties in aligning their activities with government policies, local institutions, and other humanitarian actors, which results in duplication of efforts, communication failures, and overall inefficiency in supply chain management.

Environmental challenges such as supply and demand uncertainty, political instability, and geographical barriers were also identified as key obstacles in this study. These challenges are particularly evident in conflict-affected regions, where the instability of both local governance and infrastructure makes the transportation and delivery of goods incredibly difficult [6]. These findings align with the work of [36], who identified environmental instability as one of the core challenges in humanitarian logistics [36].

Moreover, technical challenges related to the use of information systems and tracking technologies were highlighted by the study respondents. The findings are consistent with the work of [37] and [38], who noted that insufficient data analytics and a lack of real-time tracking technologies impede the decision-making process and overall logistics efficiency in humanitarian supply chains [37, 38]. This technical gap becomes especially problematic when responding to complex emergencies, where the need for rapid, data-driven decisions is critical.

Limitations of the study

One of the key limitations of this study is the relatively small working dataset used for analysis. While the sample size in this study was modest, it is worth noting that similar studies have used even smaller samples [39]. Despite this, the small sample size may limit the generalizability of the findings and could influence the precision and robustness of the results. Another limitation is the susceptibility to respondent bias. The participants in this study were primarily managerial staff, and as such, their responses may have been influenced by their position within the organizations. It is possible that some respondents did not answer the questions based on actual ground practices but rather based on perceived managerial shortcomings or concerns that the failure in logistics management was due to their inability to manage. Additionally, some participants may have answered questions in a way that they believed was aligned with the program’s goals, potentially skewing the results. This potential response bias could affect the accuracy of the findings. Furthermore, the study did not include key actors in the humanitarian logistics operations, such as developmental partners, health facilities, private healthcare providers, beneficiaries, or logistics practitioners at the headquarters level of the studied organizations. The exclusion of these groups may limit the comprehensiveness of the findings, as they play significant roles in humanitarian operations. As a result, the generalizability of the results to broader humanitarian logistics management practices may be compromised. Additionally, due to time and resource constraints, the study did not examine the performance factors at important levels of operation, such as at the Regional Health Bureaus (RHBs), EPSS hubs, EPHI regional laboratories, or public health emergency management health facilities. These operational levels could have provided valuable insights into the performance barriers and logistical challenges faced at the ground level during public health emergencies. However, despite these limitations, this study also possesses notable strengths. One of the key strengths is that it covers the major governmental bodies responsible for humanitarian logistics management throughout the country, specifically the MOH, EPSS, and EPHI. These organizations are central to the global humanitarian response operation, where the host government is considered the first responder in any emergency situation. This focus on government agencies makes the study highly relevant for understanding the challenges and logistics practices at the national level. Moreover, the study’s focus on the perceptions of managers and senior officers is another strength. These individuals are intimately familiar with the logistics challenges in their departments and have valuable insights into the disruptions and barriers that affect the operations. As Wang and Yen (2015) noted, perception-based research is a common and accepted approach in logistics literature, as it provides a direct understanding of how senior staff view and manage operational disruptions [39].

Conclusion

In general, the participants in this study reported that most of the humanitarian logistics management practices were either not being applied or were applied only moderately within the Ministry of Health (MOH), the Ethiopian Pharmaceutical Supply Service (EPSS), and the Ethiopian Public Health Institute (EPHI). According to the findings, EPHI officers assessed that the humanitarian logistics practices related to Public Health Emergency (PHE) pharmaceuticals were more extensive compared to their counterparts at MOH and EPSS. These observations suggest a significant gap in the application of effective logistics practices across the organizations involved. The findings underscore the urgent need for improving the operational practices within these organizations, particularly in managing the logistics of pharmaceuticals during emergencies. By addressing these deficiencies and adopting best practices in logistics management, these organizations can enhance their overall operations and significantly improve the delivery of aid during public health emergencies.

This study further identified several challenges faced by MOH, EPSS, and EPHI in their humanitarian logistics management operations. Among the most pressing issues were the lack of competent local transportation providers, the unsuitability of topography, facility location problems, and a lack of partnerships with third-party transportation organizations. High staff turnover among supply chain experts also exacerbated the situation, hindering the development of consistent and efficient logistics management practices. Interestingly, the study found that the challenges faced by these organizations were largely similar, with no significant differences in their challenge profiles. This suggests that the barriers to effective humanitarian logistics management in Ethiopia are systemic, and improvements across the sector are needed.

The findings from this research make a meaningful contribution to the understanding of the current state of humanitarian logistics management, particularly in relation to pharmaceutical supply chains. By highlighting the challenges and inefficiencies, this study provides valuable insights for organizations seeking to enhance their operational excellence in delivering timely and effective humanitarian aid. The study emphasizes that these inefficiencies can have dire consequences, including delayed or reduced pharmaceutical supplies to beneficiaries, leading to loss of life, increased suffering, and unnecessary costs due to logistical inefficiencies. Addressing these issues is critical not only for improving supply chain efficiency but also for ensuring that humanitarian aid reaches those in need promptly and effectively, ultimately saving lives and reducing the burden of public health emergencies.

Recommendation

Given the critical role of pharmaceutical supply chains in humanitarian response, strengthening Pharmaceutical Supply Chains for Humanitarian Response is a key recommendation. This study highlights the importance of addressing various logistical challenges, from procurement to transportation, in ensuring the timely and effective delivery of medical supplies. To improve humanitarian logistics practices for Public Health Emergencies (PHE), the following specific recommendations are proposed:

• ❖ Firstly, streamlining procurement and transportation is crucial. This involves implementing systemic changes to modernize and improve the efficiency of procurement and transportation practices. Identifying and addressing the root causes of challenges across multiple dimensions (organizational, social, technical, economic, and environmental) will be key to reducing delays, improving reliability, and ensuring that life-saving medicines reach those in need quickly. Streamlining processes such as customs clearance, contracting procedures, and supplier coordination can significantly reduce logistical bottlenecks.

• ❖ Secondly, there is a need for shifting from reactive to proactive management. Humanitarian logistics should prioritize cause-oriented logistics practices by actively engaging in scientific methods and ongoing operational excellence improvement initiatives. This proactive approach will allow for better identification, evaluation, and mitigation of potential challenges in public health emergencies. By focusing on anticipation and preparedness rather than responding to issues reactively, organizations can increase the effectiveness of their operations and ensure that they are ready for future crises.

• ❖ Lastly, optimizing logistics processes is essential. Key areas for improvement include regular market assessments, building strong relationships with reliable suppliers, optimizing order quantities and frequencies, enhancing demand planning, strategically placing distribution centers, utilizing technology for cost-effective routing and real-time tracking, implementing automation to improve operational efficiency, and continuously monitoring and improving performance.

• ❖ Moreover, it is critical to develop a comprehensive procurement strategy, enhance transportation management practices, foster improved coordination among stakeholders, streamline customs procedures, and invest in staff training for better logistics management. These recommendations aim to create a more efficient, reliable, and agile pharmaceutical supply chain that can meet the urgent needs of affected populations during public health emergencies.

Authors’ contributions

BT: conceptualization, data validation, methodology, formal analysis, writing-original draft, and writing review and final editing.ST: conceptualization, instrument validation, methodology, formal analysis, writing-original draft, and writing review and final editing. All the authors have read and approved the final manuscript.

Funding

The authors declare that the research was conducted in the absence of any funding that could be construed as a potential conflict of interest.

Data availability

The original contributions presented in the study are included in the article/Supplementary material, and further inquiries can be directed to the corresponding author.

Declarations

Ethics approval and consent to participate

All ethical protocols of the study were carried out following the relevant guidelines and regulations of the Declaration of Helsinki and approved by the Ethical Review Committee (ERC) of Addis Ababa University, School of Pharmacy, under reference number ERB/SOP/373/14/2021. Before data collection, the respondents were informed about the purpose and objective of the study, and written informed consent was obtained from each respondent. The identity of the respondents was kept confidential.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.