This paper analyzes challenges facing Tanzania's public pharmaceutical sector supply chain and distribution network. It finds critical issues like delays in government funding to the Medical Stores Department, expensive medicines costing over $20 million annually, and a $24 million debt. There are also lack of stock control, poor demand and stock information flow, and forecasting errors. This leads to delays, stockouts, and medicine shortages. The poor supply chain performance negatively impacts access to medicines and health care quality. The paper recommends integrating activities across the supply chain and collaborating between participants to improve performance using a process innovation model.