Stock-outs of essential health products in Mozambique - longitudinal analyses from 2011 to 2013.
OBJECTIVE
To assess the relationship between health system factors and facility-level EHP stock-outs in Mozambique.


METHODS
Service provisions were assessed in 26 health facilities and 13 district warehouses in Sofala Province, Mozambique, from July to August in 2011-2013. Generalised estimating equations were used to model factors associated with facility-level availability of essential drugs, supplies and equipment.


RESULTS
Stock-out rates for drugs ranged from 1.3% for oral rehydration solution to 20.5% for Depo-Provera and condoms, with a mean stock-out rate of 9.1%; mean stock-out rates were 15.4% for supplies and 4.1% for equipment. Stock-outs at the district level accounted for 27.1% (29/107) of facility-level drug stock-outs and 44.0% (37/84) of supply stock-outs. Each 10-km increase in the distance from district distribution warehouses was associated with a 31% (CI: 22-42%), 28% (CI: 17-40%) or 27% (CI: 7-50%) increase in rates of drug, supply or equipment stock-outs, respectively. The number of heath facility staff was consistently negatively associated with the occurrence of stock-outs.


CONCLUSIONS
Facility-level stock-outs of EHPs in Mozambique are common and appear to disproportionately affect those living far from district capitals and near facilities with few health staff. The majority of facility-level EHP stock-outs in Mozambique occur when stock exists at the district distribution centre. Innovative methods are urgently needed to improve EHP supply chains, requesting and ordering of drugs, facility and district communication, and forecasting of future EHP needs in Mozambique. Increased investments in public-sector human resources for health could potentially decrease the occurrence of EHP stock-outs.
Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Health Alliance International, Beira, Mozambique.
Bradley H
BH
Wagenaar
Sarah
S
Gimbel
Roxanne
R
Hoek
James
J
Pfeiffer
Cathy
C
Michel
João Luis
JL
Manuel
Fatima
F
Cuembelo
Titos
T
Quembo
Pires
P
Afonso
Stephen
S
Gloyd
Kenneth
K
Sherr
D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000639:trends*; D018954:Drugs, Essential / Q000600:supply & distribution*; D004864:Equipment and Supplies / Q000600:supply & distribution*; D006268:Health Facilities / Q000706:statistics & numerical data / Q000639:trends*; D006285:Health Planning; D006297:Health Services Accessibility / Q000639:trends; D006302:Health Services Research / Q000379:methods; D054625:Healthcare Disparities; D006801:Humans; D008137:Longitudinal Studies; D009073:Mozambique; D010593:Pharmaceutical Services / Q000600:supply & distribution / Q000639:trends; D019035:Rural Health Services / Q000706:statistics & numerical data / Q000639:trends*; D000078329:Workforce; D014944:World Health Organization
D018954:Drugs, Essential
Investigación en Servicios Sanitarios; Investigación en implementación; Planeación Sanitaria; Provisión de servicios sanitarios; Recursos Sanitarios; Servicios farmacéuticos; delivery of health care; dispensation des soins de santé; health planning; health resources; health services research; implementation research; implémentation de la recherche; pharmaceutical services; planification de la santé; recherche sur les services de santé; ressources pour la santé; services pharmaceutiques