Conference Agenda

Background: Logistics resilience theory has long assumed that efficiency and redundancy trade off against each other. Humanitarian pharmaceutical supply chains in low- and middle-income countries where temperature-sensitive, life-critical commodities move through donor-funded, multi-tier networks under extreme demand uncertainty, severe last-mile constraints, cold-chain requirements, and recurrent disruption constitute a natural laboratory for examining how organizational capabilities generate resilience under fundamental uncertainty. This systematic review asks which capability clusters characterize these chains, how they operate, and what transferable lessons they offer logistics and supply-chain management.

Methods: We conducted a complete search of electronic databases from inception to April 2026. Inclusion criteria: peer-reviewed empirical studies set in LMICs, focused on organizational capabilities or resilience practices in health-commodity supply chains, and reporting at least one supply-chain performance indicator or health-access outcome. Exclusion criteria: general humanitarian logistics without a medical-commodity focus; non-empirical work; high-income-country-only settings. Quality appraisal used MMAT (2018), and findings were synthesized through CIMO extraction and thematic analysis and interpreted through dynamic capabilities theory.

Results: 41 studies met inclusion criteria, with evidence concentrated in Ethiopia, Ghana, Nigeria, Uganda, Kenya, and Tanzania. Six recurring capability clusters emerged: coordination and collaboration, agility and resilience, technology-enabled logistics, procurement and financing, workforce and adaptive learning, and governance and regulation.

Coordinated routines were the dominant mechanism (37/41), while information sharing and interorganizational trust each appeared in (25/41). Capabilities operated under recurring constraints, including institutional and regulatory weakness, infrastructure limitations, donor funding volatility, and limited health system capacity. The strongest empirical performance finding was a 43% reduction in procurement lead times reported by Ethiopia's Pharmaceuticals Supply Agency following procurement and supply-chain reforms. Only indirect health-outcome linkages were identified. These findings indicate a capability architecture for logistics systems operating under fundamental uncertainty. Across studies, organizational capabilities generated resilience through three recurring mechanisms: coordinated routines, information sharing, and interorganizational trust, suggesting how capabilities are converted into resilient performance under conditions of disruption. The evidence further indicates that sustained performance improvements depend less on the adoption of individual technologies than on their integration within broader coordination and governance structures.

These findings offer a new perspective on the efficiency–resilience trade-off by suggesting that coordination and information sharing help organizations balance redundancy and agility under crisis conditions. The absence of evidence linking capabilities to population-level outcomes reveals a persistent capability-to-value gap and informs the development of the Sustainability–Capability–Resilience–Catastrophic Health Expenditure framework as a future research agenda.

Conclusions: This review reframes humanitarian pharmaceutical supply chains as a natural laboratory for examining how organizational capabilities generate resilience under fundamental uncertainty. It identifies a transferable capability architecture comprising six capability clusters and shows that resilience emerges through coordinated routines, information sharing, and inter-organizational trust. The findings suggest that sustained performance improvements depend on institutionalized capabilities rather than stand-alone interventions and reveal a persistent capability-to-value gap due to the lack of direct evidence linking capabilities to population-level outcomes. The study contributes to logistics and supply-chain management by clarifying how capabilities translate into resilient performance and highlighting the need for context-specific capability measurement and resilience assessment.