Sefako Makgatho Health Sciences University (SMU) continues to demonstrate its commitment to advancing health systems innovation through impactful doctoral research aimed at solving some of South Africa’s most persistent healthcare challenges. A newly completed PhD study by Dr Mmabatho Miriam Ndwandwe has introduced a comprehensive governance framework designed to address chronic medicine shortages in public health facilities across the Eastern Cape Province, a problem that continues to undermine patient care and delay progress towards universal health coverage.
Medicine stock-outs remain one of the most critical barriers to effective healthcare delivery in South Africa’s public sector. Despite existing procurement policies and regulatory frameworks, many facilities continue to experience frequent shortages of essential medicines, exposing deep structural weaknesses in governance, accountability and supply chain coordination. Dr Ndwandwe’s research responds directly to this challenge by proposing a practical, evidence-based framework to strengthen medicine governance from provincial to facility level.
At the heart of the study is a clear warning about the systemic nature of the problem. “Medicine shortages in the public health system are not only a supply chain issue, but a governance failure that requires coordinated leadership, transparency and accountability at every level of the system,” said Dr Ndwandwe, highlighting the urgency for structural reform.
Her doctoral research adopted a sequential explanatory mixed-methods design, combining quantitative data from 394 healthcare professionals with qualitative insights drawn from 20 in-depth interviews with healthcare managers operating at both facility and provincial levels. The study included nurses, pharmacists and medical officers across clinics, community health centres and hospitals in the Eastern Cape, ensuring a comprehensive view of the health system.
The quantitative findings revealed that more than 70 per cent of respondents reported frequent medicine stock-outs that severely disrupted service delivery. Statistical analysis further showed significant associations between perceptions of stock management and professional category, indicating inconsistencies in how shortages are experienced across different healthcare roles.
The qualitative phase provided deeper insight into the structural drivers of these shortages. Participants identified weak pharmaceutical supply chain systems, fragmented communication channels, poor budget transparency, limited functionality of Pharmacy and Therapeutics Committees (PTCs), and inadequate accountability mechanisms as key contributors to ongoing challenges.
“Health professionals consistently highlighted the lack of coordination between procurement processes and facility-level needs,” Dr Ndwandwe explained. “Without functional governance structures and clear accountability systems, even well-designed policies fail to translate into reliable medicine availability.”
Using the World Health Organization’s Good Governance for Medicines (GGM) Model as a guiding framework, the study developed a four-pillar governance model. This includes strengthened leadership and accountability mechanisms, improved transparency in procurement and financial systems, enhanced functionality of governance structures such as PTCs, and improved capacity-building alongside compliance monitoring.
Stakeholder validation confirmed that the framework is both practical and aligned with the National Health Act and international governance standards. Experts noted its strong potential to improve coordination between provincial authorities and frontline healthcare facilities, thereby strengthening the overall efficiency of medicine supply systems.
Dr Ndwandwe, who brings extensive experience in public health leadership, including roles as a hospital Chief Executive Officer and senior provincial health manager, said her work is grounded in practical experience. Her background in pharmacy, supply chain management and health systems governance adds critical depth to the study’s findings and recommendations.
The research concludes that resolving medicine shortages requires more than logistical fixes; it demands a transparent, accountable and fully integrated governance system that connects policy with implementation. The proposed framework offers a realistic and scalable pathway towards achieving this transformation.
SMU emphasised that research of this nature reflects its broader mission to produce knowledge that directly responds to national health priorities. Through rigorous academic inquiry and innovation, the university continues to strengthen South Africa’s health systems and improve access to essential medicines.
As the country works towards achieving universal health coverage, Dr Ndwandwe’s research stands as a significant contribution, demonstrating how SMU continues to shape solutions that improve healthcare delivery and ultimately enhance the well-being of communities across South Africa.
By Tumelo Moila.
