Demand management in public healthcare: an institutional and operational assessment of Gauteng hospitals, South Africa

PURPOSE: This study examined the institutional and operational dimensions of demand management in Gauteng public hospitals, South Africa. It evaluated compliance with supply chain management (SCM) policies, identified barriers to procurement planning and analysed variations across hospital categories. DESIGN/METHODOLOGY/APPROACH: A cross-sectional survey was conducted among 235 senior SCM practitioners across 47 hospitals. Descriptive statistics, correlation, regression, ANOVA and mediation analyses were employed to test six hypotheses derived from Institutional Theory, Street-Level Bureaucracy and Winter's Integrated Implementation Model. FINDINGS: Compliance with relevant legislation (PFMA and PPPFA) and constitutional requirements was uniformly high, reflecting isomorphic behaviour within a rule-dense regulatory environment. However, capability-intensive practices varied: specification quality and stakeholder engagement were positively associated with compliance, while digital integration strongly predicted demand-management effectiveness and procurement performance. Although compliance improved planning quality, it did not directly influence throughput. Operational challenges, including budget constraints, skills shortages and structural fragmentation, weakened the impact of digital integration. Modest differences across hospital tiers indicated that tertiary hospitals outperformed primary hospitals in role-player effectiveness. RESEARCH LIMITATIONS/IMPLICATIONS: The study's focus on Gauteng limits generalisability, and its cross-sectional design does not capture longitudinal or post-COVID reforms. PRACTICAL IMPLICATIONS: Reforms should prioritise decentralised procurement authority, digital tools adoption, strengthened SCM capacity and integrated planning to improve efficiency and medicine availability. ORIGINALITY/VALUE: This study presents one of the first empirical assessments of hospital-level demand management in South Africa. It contributes to global SCM scholarship by linking institutional structures, operational practices and compliance in low- and middle-income country contexts.