Spatial disparities in drug stock-outs in Zimbabwe

Drug stock-outs are a public health challenge, especially in developing countries. These drug stock-outs are worsened by poor supply chain management, limited financial resources and shortages of experienced health workers. Regardless of the prevalence of drug stock-outs, a few studies examine the spatial disparities in, and factors influencing, these stock-outs. In this paper, we investigate the spatial disparities in drug stock-outs and factors contributing to this to bridge the existing literature gap. We use the 2018–20 administrative drug stock-out data from Zimbabwe’s Ministry of Health and Child Care. To achieve the objective, thematic maps are used to map out stock-outs while a random effects model examines factors affecting stock-outs. The results highlight the existence of regional disparities in drug stock-out and establish the presence of spatial autocorrelation in drug stock-outs, indicated by hot spots and cold spots. Additionally, regions with higher rates of disease prevalence and poor road infrastructure development have a higher prevalence of drug stock-outs than other regions. Notably, drug stock-outs are high for facilities with previous stock-outs and a long time for drug delivery, as well as for clinics and facilities in rural areas. The existence of high drug stock-outs in rural and hard-to-reach areas is a potential threat to the attainment of universal health coverage in Zimbabwe. Thus, policy should aim to improve the availability of essential drugs through improvements in supply chain management and ensuring drug distribution to the last mile. Strengthening sector-wide coordination between various Ministries could also help in reducing the prevalence of drug stock-outs.Key messages There is a high prevalence of drug stock-out in many developing countries and this is also confirmed for Zimbabwe.The high stock-out in Zimbabwe is localised to regions with high rates of diseases and a poor road infrastructure network.There are inter-linkages in stock-outs between facilities and clinics in rural areas and facilities with previous stock-outs.Improvements in supply chain management and sector-wide coordination between various Ministries could help reduce the potential threat that drug stock-out presents to the attainment of universal health coverage.