• Bradley H Wagenaar, Sarah Gimbel, Roxanne Hoek, James Pfeiffer, Cathy Michel, João Luis Manuel, Fatima Cuembelo, Titos Quembo, Pires Afonso, Stephen Gloyd, and Kenneth Sherr.
• Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA; Health Alliance International, Beira, Mozambique.
• Trop. Med. Int. Health. 2014 Jul 1; 19 (7): 791-801.

ObjectivesTo assess the relationship between health system factors and facility-level EHP stock-outs in Mozambique.MethodsService 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.ResultsStock-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.ConclusionsFacility-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.© 2014 John Wiley & Sons Ltd.

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