Determinants of Supply Chain Resilience of Operating Theatre Supplies in Lusaka District, Zambia: The Role of Demand Forecasting and Lead-Time Management

Background: Ensuring the consistent availability of operating theatre supplies is critical for safe surgical care. However, supply chain disruptions remain common in low- and middle-income countries (LMICs). In Zambia, commodity security policies have been implemented to improve the supply systems. However, their effectiveness in enhancing supply chain resilience is poorly understood. This study assessed the determinants of supply chain resilience for operating theatre supplies in Lusaka District, Zambia. Methods: A convergent parallel mixed-methods study was conducted among healthcare personnel involved in supply chain management across tertiary and first-level hospitals and the Zambia Medicines and Medical Supplies Agency (ZAMMSA). Quantitative data were collected from 120 respondents using structured questionnaires and analysed using descriptive statistics, chi-square tests, and multivariable logistic regression. Qualitative data were obtained from 15 purposively selected key informants and were analysed thematically. The findings were integrated using joint display analysis. Results: Demand forecasting capacity and effective lead-time management were both strongly associated with surgical supply chain resilience, with demand forecasting showing an adjusted odds ratio (AOR) of 22.0 (95% CI: 1.52 - 319.1; p = 0.023) and effective lead-time management showing an AOR of 12.8 (95% CI: 1.64 - 100.4; p = 0.010). Although inventory management showed a strong association at the bivariate level (COR = 12.70; 95% CI: 3.49 - 46.24; p p = 0.643). Commodity security policies were not statistically significant in the adjusted model. Qualitative findings highlighted gaps in logistics management information system utilisation, data-driven decision-making, and coordination across supply chain actors. Conclusion: The resilience of the supply chain for operating theatre supplies in Lusaka District was primarily associated with operational factors, particularly demand forecasting and lead-time management. Strengthening these functions, along with improving data use and operational coordination, was found to be essential for enhancing the effectiveness of commodity security policies that ensure uninterrupted surgical services.