Effective risk monitoring and control mechanisms are critical to the continuity, reliability, and efficiency of public health supply chains, particularly where disruptions in medical commodity supply can adversely affect healthcare service delivery. This study examined the effect of risk monitoring and control mechanisms on service delivery performance in Kenya’s public health sector, focusing on the Kenya Medical Supplies Authority (KEMSA). The study was anchored on Dynamic Capabilities Theory and Systems Theory, which explain the importance of continuous environmental scanning, feedback, adaptation, and corrective action in maintaining organizational performance. A descriptive research design was adopted. The target population comprised 270 employees drawn from key departments at KEMSA headquarters in Nairobi, while a sample of 161 respondents was determined using Yamane’s formula and selected through stratified random sampling. Primary data were collected using structured questionnaires based on a five-point Likert scale. Of the 161 questionnaires administered, 148 were successfully completed and returned, representing a response rate of 91.9%. Data were analysed using descriptive statistics, Pearson correlation analysis, and regression analysis with the aid of SPSS Version 28. The descriptive findings established that risk monitoring and control mechanisms were strongly implemented, recording an overall mean of 4.07 and standard deviation of 0.86. Correlation analysis established a strong, positive and statistically significant relationship between risk monitoring and control mechanisms and service delivery performance (r = 0.769, p < 0.05). Regression analysis further established that risk monitoring and control mechanisms had the strongest influence on service delivery performance among the supply chain risk management dimensions examined (β = 0.337, p < 0.001). The study concluded that continuous monitoring, management review, internal audits, performance tracking, and effective use of risk information substantially enhance operational efficiency, timeliness, cost management, and customer satisfaction. The study recommends strengthening integrated digital monitoring systems, automated early-warning mechanisms, real-time supply chain tracking, and risk performance dashboards within public health institutions.