Sustainable Supply Chain Management Practices and Performance of County Referral Hospitals in Kenya

County referral hospitals in Kenya continue to grapple with persistent shortages of essential medicines and medical supplies, escalating operational costs, growing volumes of medical waste and inefficiencies in supply chain operations, all of which undermine the quality of healthcare delivery. Although sustainable supply chain management practices have been widely acknowledged as a strategic solution to these challenges, their adoption and implementation within county referral hospitals remains fragmented and largely undocumented. The general objective of this study was to assess the effect of sustainable supply chain management practices on the performance of county referral hospitals in Kenya. Specifically, the study sought to determine the effect of green procurement practices, supply chain integration practices, technological integration practices and environmental conservation practices on the performance of county referral hospitals in Kenya. The study was anchored on the Natural Resource-Based View theory, and supported by the Diffusion of Innovation theory, Institutional theory and Stakeholder theory. The study adopted a descriptive survey research design. The target population comprised 188 respondents drawn from the 47 county referral hospitals in Kenya, consisting of hospital administrators, procurement officers and supply chain officers. Using the Yamane (1967) formula, a sample size of 128 respondents was obtained through stratified random sampling. Primary data was collected using structured questionnaires administered through the drop-and-pick-later method. A pilot study was conducted on 13 respondents representing 10% of the sample to test the validity and reliability of the research instrument, with all constructs returning Cronbach's Alpha coefficients above the 0.7 threshold. Data was analyzed using descriptive statistics and inferential statistics with the aid of SPSS Version 25. The study achieved a response rate of 81.3%. The regression results revealed that the four sustainable supply chain management practices jointly explained 61.9% of the variation in the performance of county referral hospitals (R² = 0.619). Green procurement practices (β = 0.268, p = 0.000), supply chain integration practices (β = 0.219, p = 0.003), technological integration practices (β = 0.301, p = 0.000) and environmental conservation practices (β = 0.184, p = 0.009) all had positive and statistically significant effects on the performance of county referral hospitals in Kenya. The study concluded that sustainable supply chain management practices significantly enhance the performance of county referral hospitals in Kenya, with technological integration practices having the greatest effect. The study recommends that county governments and hospital management should institutionalize green procurement policies, deepen integration and information sharing with suppliers and healthcare partners, accelerate investment in digital supply chain technologies and embed environmental conservation programmes in hospital operations. The findings are expected to benefit policy makers, county health managers, procurement practitioners and scholars in the field of sustainable supply chain management.