[DSRP Evidence](https://dsrpevidence.org/)

# A Systems Approach to Ethical Public Procurement in the Medical Sector

## Details

**Authors** Du Plessis, Lihani

**Year** 2026

**Publisher** University of Cambridge (PhD thesis, Apollo repository)

**Kind of work** thesis

**Discipline** Engineering

**Secondary disciplines** Public Health, Public Policy, Business & Management

**Kind of engagement** scholarly

**Applied** true

[Read it at the publisher](https://doi.org/10.17863/cam.133388) 
10.17863/cam.133388

## In authors' words

### What they set out to do (purpose)

To ask what prevents public health systems from procuring ethically, taking modern slavery in the supply chains of England's NHS as its case, and how a systems thinking approach can reveal and address the constraints involved.

### Who or what was studied (sample)

Twenty-six semi-structured expert interviews with procurement and ethical buying professionals across six European countries, plus a focus group of systems thinking researchers.

### How they did it (methods)

An interdisciplinary, exploratory qualitative study drawing on supply chain research, modern slavery research, health policy and systems research, and systems thinking, with DSRP theory and an Agent-Based Approach as its analytical framework.

### What they found (results)

Du Plessis concludes that complexity, power, and responsibility are interrelated emergent properties of complex adaptive systems and among the largest barriers to ethical procurement; that the NHS, a health system of systems under stress with low procurement maturity, currently lacks the culture, capacity, and resources to address modern slavery in its supply chains; and hypothesizes that procurement maturity is the key factor for implementing human rights due diligence. The thesis also offers a preliminary evaluation of the Agent-Based Approach's strengths and limitations.

## Commentary

### In short

A Cambridge PhD thesis on modern slavery in NHS medical supply chains names DSRP theory, paired with an agent-based approach, as its analytical framework for 26 expert interviews across six European countries.

### Response

The thesis puts DSRP on the kind of problem the theory is built for. Where does a procurement system's responsibility end is a boundary question; an eighty-thousand-supplier chain sitting inside a health system of systems is a part-whole question; how cost pressure at the center propagates to a supplier's labor practices is a relationship question; whose account of responsibility counts is a perspective question. The headline finding, that complexity, power, and responsibility are emergent rather than local properties, is the sort of result the systems and relationship rules are meant to surface, and reaching it through interviews rather than argument is worth something. Two things cannot be checked from the repository record, which is all that is currently available: how the four rules were operationalized in coding the twenty-six interviews, and what analytic work DSRP did as against the Agent-Based Approach it is paired with. The abstract names both as the framework without dividing the labor between them.

**Patterns it shows** D, S, R, P

Shows it makes a difference

**Added** 2026-10-26

**How to cite this** Du Plessis, Lihani (2026). A Systems Approach to Ethical Public Procurement in the Medical Sector. University of Cambridge (PhD thesis, Apollo repository).