Background: This study describes the incentives and barriers of public procurement ofcellulose-based and locally produced textiles in the Swedish healthcaresector governed by the county councils and regions. The size of the publicprocurement market is substantial which makes it imperative to analyse theprocurement decisions taken by this large customer from asustainability perspective. To understand these decisions better the publicprocurement is also analysed from an organisational perspective discussingpressures from global, regional and local stakeholders and governingauthorities.Methods: Empirical and primary data was collected from three semi-structuredinterviews with procurement officers, strategic buyers and heads ofprocurement departments in three county councils and regions in Sweden.The qualitative data was supplemented with quantitative data from a surveytargeting the additional 18 county councils and regions in Sweden. All 21county councils and regions in Sweden participated in or responded to theinterview and survey study. Six (33 %) complete responses were submitted,while five (28 %) surveys were partially responded to. Seven (39 %) countycouncils and regions did not participate in the study. The quantitative surveydata was analysed through the Fisher’s exact test and a thematic analysis wasapplied jointly on the interview and survey data due to the identicalinterview and survey questions.Results: The four themes found in the empirical data were concluded to be thedecision-making in these procurement processes being affected by manystakeholders, a high trust on suppliers for information updates andsustainable responsibility, an existing knowledge gap on cellulose-based andlocally produced textiles and the challenges and opportunities surroundingthe regulation of sustainability in the contract terms in the publicprocurement of textiles. The procurement officials being in a leading or nonleadingposition did not show any statistically significant effect on theperception of the clarity in the relevant political directives and how thisinfluences the possibility to take sustainable action in the procurementprocess, nor on whether the short-term (lowest) price has a higher prioritythan the long-term (e.g. long-term societal and environmental costs) in theprocurement of textiles.Conclusion: The sustainable public procurement of textiles within the Swedish healthcaresector governed by the county councils and regions is characterized by ahigh level of organisational complexity including many global, regional andlocal stakeholders. The governing authorities as well as the procuringorganizations and suppliers show interest in implementing sustainableprocurement processes which is however aggravated by static contract terms,limited knowledge on novel textile materials and the perceived costs relatedto the procurement.