LAUSR

Abstract Sustainable procurement is an integral part of public sector sustainability, but developing countries are far behind in this area. This study explores the internal and external challenges in Pakistan's public health sector that hamper sustainable procurement. With the help of experts, we found eleven key challenges that hamper sustainability in public health sector procurement. We designed an instrument and fielded it to eighty-five procurement officials in government hospitals, who verified the presence of the challenges in health sector. The interpretative structural modelling (ISM) we used to develop a hierarchy among the identified challenges reflects that government regulations and senior management's commitment—all strategic challenges—are the most critical challenges, whereas perceived ineffectiveness, third-party involvement, and the unavailability of green products—all operational challenges—are less critical. The study presents comprehensive recommendations to policymakers and future researchers related to achieving sustainable development goals in the health sector.