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

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.