# Essential Medicines Availability, Pricing, and Stock-Outs for Hypertension and Diabetes in Private Retail Pharmacies in Zimbabwe

## TL;DR

This study examines the availability and pricing of essential medicines for hypertension and diabetes in private pharmacies in Zimbabwe, finding that while medicines are generally available, high prices pose a major barrier to access.

## Contribution

The study provides the first empirical evidence on medicine availability, pricing, and stock-out patterns in Zimbabwe's private retail pharmacies for non-communicable diseases.

## Key findings

- Most essential medicines for hypertension and diabetes were available in over 80% of pharmacies.
- Local retail prices exceeded international reference prices and public facility prices, creating affordability barriers.
- High retail prices and comorbidity of hypertension and diabetes increase out-of-pocket expenses and risk treatment adherence.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Hypertension and diabetes are major contributors to morbidity and mortality in Zimbabwe, yet reliable access to essential medicines remains a critical health system-wide challenge.Private retail pharmacies increasingly serve as a key alternative source of chronic disease medicines amid recurrent public-sector stock-outs.

Hypertension and diabetes are major contributors to morbidity and mortality in Zimbabwe, yet reliable access to essential medicines remains a critical health system-wide challenge.

Private retail pharmacies increasingly serve as a key alternative source of chronic disease medicines amid recurrent public-sector stock-outs.

Public health significance—Why is this work of significance to public health?
This study provides empirical evidence on medicine availability, pricing, and stock-out patterns in private pharmacies, addressing a major evidence gap in the Zimbabwean NCD medicine landscape.The findings highlight substantial price disparities between private retail markets, public facilities, and international reference prices, revealing potential affordability barriers for patients with NCDs.

This study provides empirical evidence on medicine availability, pricing, and stock-out patterns in private pharmacies, addressing a major evidence gap in the Zimbabwean NCD medicine landscape.

The findings highlight substantial price disparities between private retail markets, public facilities, and international reference prices, revealing potential affordability barriers for patients with NCDs.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
High and variable retail medicine prices, combined with the high prevalence of HTN–DM comorbidity, can significantly increase out-of-pocket spending and jeopardize long-term treatment adherence.Strengthening pricing regulation and optimizing supply-chain processes are essential policy priorities to ensure equitable access to essential NCD medicines in urban private-sector markets.

High and variable retail medicine prices, combined with the high prevalence of HTN–DM comorbidity, can significantly increase out-of-pocket spending and jeopardize long-term treatment adherence.

Strengthening pricing regulation and optimizing supply-chain processes are essential policy priorities to ensure equitable access to essential NCD medicines in urban private-sector markets.

Background: Access to affordable essential medicines is critical for effective management of hypertension (HTN) and diabetes mellitus (DM). In Zimbabwe, frequent stock-outs in public facilities position private pharmacies as important alternative sources of these medicines. Aim: To assess availability, pricing, and stock-out levels of essential HTN and DM medicines in private retail pharmacies in Gweru Urban District, Zimbabwe. Methods: A cross-sectional survey was conducted in 40 registered private pharmacies. Data on medicine availability, retail prices, monthly stock-outs, and supply-chain factors were collected using a structured interviewer-administered questionnaire, stock cards, and observational checklists. Local prices were compared with international reference prices (IRPs). Chi-square analyses evaluated associations between pharmacy characteristics, medicine prices, availability, and stock-out durations. Results: Most tracer medicines for HTN and DM were available in ≥80% of pharmacies, with average stock-outs generally <3 days per month. Pharmacy characteristics were not significantly associated with availability or stock-outs. Medicines with <80% availability and those priced at ≥USD 5 were significantly associated with prolonged stock-outs of ≥7 days (p = 0.006 and p = 0.001, respectively). Local retail prices exceeded IRPs and public facility prices, suggesting potential affordability barriers in the context of an economic crisis, where most health expenditures are out-of-pocket. Key drivers of stock-outs included wholesaler shortages, delivery delays, limited procurement funds, and substitution with alternative medicines. Conclusions: While medicine availability and short-term stock-outs were generally favourable, high retail prices pose a major potential barrier to access. The cost burden is amplified by the common HTN-DM comorbidity, requiring multiple medications per person, thereby further increasing out-of-pocket expenses. High prices may limit adherence, reduce functional capacity, and negatively impact productivity. Policy interventions targeting pricing regulations and value-chain optimization are urgently needed to enhance equitable access to essential NCD medicines in urban Zimbabwe.