Determinants of Reverse Logistics Adoption for Medical Supplies and Pharmaceutical Waste: A Case Study of Kabwe District, Zambia

Abstract

Reverse logistics (RL) for medical supplies and pharmaceutical waste remains underexamined in sub-Saharan Africa, despite rising volumes of expired medicines and increasing regulatory pressure for environmentally sound disposal. This study examined the determinants of RL adoption in Kabwe District, Zambia. Grounded in Institutional Theory and the Resource-Based View, the study employed a convergent parallel mixed-methods design.

Quantitative data were collected through questionnaires administered to 136 health facility and pharmacy personnel, while qualitative data were gathered through 15 key informant interviews and 8 focus group discussions. Binary logistic regression, chi-square tests, and thematic analysis were used. Most facilities (69.9%) demonstrated moderate RL adoption (scores of 3–4 on a five-item index), while only 9.6% showed high adoption. In the bivariate analysis, e-LMIS use emerged as the strongest predictor of good RL practices (OR = 9.23, p < 0.001). In the multivariable model, training showed a positive but marginal association with good RL practices (aOR = 3.57, p = 0.061), barrier count was significantly associated (aOR = 2.52, p = 0.002), while rural health posts (aOR = 0.14, p = 0.017) and private pharmacies (aOR = 0.08, p = 0.002) had substantially lower odds of good practices than hospitals (Nagelkerke pseudo-R² = 0.344).

Qualitative findings indicated that the main barriers were structural and operational rather than primarily attitudinal. The findings extend Institutional Theory and the Resource-Based View to health-system RL in low- and middle-income countries, with practical implications for policy and practice.