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.

Traditional supply chain strategy models have long provided valuable frameworks for aligning operational configurations with market and product characteristics. Seminal contributions such as Fisher’s product-based classification (Fisher 1997) and Lee’s uncertainty matrix (Lee 2002) have guided managerial decision-making by linking supply chain strategy to demand and supply uncertainty. However, the growing frequency of global disruptions, increasing regulatory pressure, and the urgent need for environmental responsibility have exposed important limitations in these models. While resilience and sustainability have become central strategic imperatives, existing supply chain strategy frameworks rarely integrate these dimensions in a systematic manner.

This research addresses this gap by proposing an extension of Lee’s uncertainty matrix through the introduction of environmental impact strategic relevance as an additional dimension. The objective is to develop a more comprehensive framework capable of supporting supply chain design in contexts characterized not only by uncertainty, but also by increasing sustainability requirements. The study investigates how traditional supply chain strategy models can be adapted to better reflect the realities of contemporary business environments, where competitiveness increasingly depends on the ability to balance efficiency, resilience, and environmental responsibility.

The research adopts a qualitative multiple case study methodology and was conducted in two steps. The first step is based on published literature. Five sustainability-oriented companies operating in different industries were selected for analysis: Patagonia (apparel), Lush (cosmetics), Fairphone (electronics), Toyota (automotive), and EcorNaturaSì (agri-food). These organizations were chosen due to their strong commitment to environmental and social sustainability and the availability of extensive secondary data. The second step is an empirical investigation conducted through semi-structured interviews with managers from five additional companies (different from those selected for the first step) actively implementing ESG-related supply chain practices. A within-case and cross-case analyses were elaborated with focus on uncertainty management, ethical sourcing, traceability, circular product design, carbon footprint reduction, logistics strategies, and the interaction between sustainability and business performance.

The findings reveal that sustainability is no longer a peripheral operational concern but a strategic driver that fundamentally influences supply chain configuration. Companies increasingly adopt practices that simultaneously enhance resilience and environmental performance, including supplier diversification, transparency mechanisms, circularity initiatives, local sourcing, and collaborative governance structures. At the same time, the study identifies important trade-offs related to costs, technological constraints, and regulatory compliance.

Building on these insights, this study proposes two complementary strategic matrices that integrate environmental impact with demand uncertainty and supply uncertainty, respectively. The resulting framework introduces new interpretative quadrants and operational guidelines that better reflect contemporary supply chain realities. The study contributes to supply chain management literature by extending traditional strategic fit theories and offering a practical tool for organizations seeking to incorporate resilience and sustainability objectives. More broadly, it advances the discussion on how supply chains can evolve from efficiency-oriented systems toward adaptive, responsible, and long-term value-generating networks, despite not encompassing the social dimension, which remains an avenue for future research.

Resilience has attracted growing attention in both academia and industry. Despite the increasing focus and the growing body of literature dedicated to protective disciplines, a lack of conceptual clarity persists, regarding which elements constitute resilience and which factors are most critical for its effectiveness, particularly in industry. While organizations face numerous barriers to implementing resilience, academic research has paid limited attention to these barriers in a comprehensive and systematic manner.

This paper is based on the author’s ongoing doctoral research on resilience in industrial organizations. Resilience is conceptualized as being shaped by four interacting forces within a “resilience nexus” model: resilience constituents, IT and digital technologies as enabling factors, and internal and external barriers. Based on an extensive literature review and validation through expert interviews and focus groups, resilience constituents and barriers have been identified, described, and assessed. This paper presents a proposed functional classification of resilience constituents based on their role in building, maintaining, and executing resilience, and illustrates a new framework that extends prior temporal models by integrating a functional perspective that considers not only when resilience constituents become relevant during a disruption, but also how they contribute to resilience. This approach contributes to a more structured and holistic understanding of resilience across disruption phases.

Furthermore, the paper presents the framework developed for classifying resilience barriers, a four-cluster matrix generated by combining the categorization across two dimensions: attitudinal versus implementation barriers, and internal versus external barriers. Attitudinal barriers refer to how resilience is perceived, understood, and prioritized, whereas implementation barriers hinder the deployment of resources, tools, strategies, and processes for resilience. A total of 36 identified constraints were evaluated by a panel of experts, who largely confirmed both the categorization framework and the relevance of the identified barriers.

The findings address an important research gap by providing a more systematic and integrated perspective on resilience constituents and implementation barriers. In addition, the proposed frameworks may provide practical guidance for organizations seeking to strengthen resilience, particularly in industrial environments.