Abstract
INTRODUCTION: uninterrupted availability of tracer essential health commodities is critical for service readiness and resilient healthcare delivery. Despite reforms, Kenyan public hospitals, including Kitui County Referral Hospital continue to experience recurrent stock-outs of essential items. METHODS: this cross-sectional mixed-methods study assessed the availability of 155 tracer commodities across 22 departments at Kitui County Referral Hospital from July 2023 to June 2024. Quantitative data were collected using structured stock audits guided by the Ministry of Health 647 checklist, and qualitative insights from 12 key informant interviews. Data were analyzed using SPSS v26 and thematic analysis. Triangulation enhanced data analysis and interpretation. RESULTS: only 2 of 22 departments (9.1%) met the WHO-recommended 80% availability threshold. Availability ranged from 29% in the non-pharmaceutical store to 100% in the dental and nutrition departments. Critical shortages affected high-demand areas like the intensive care unit (73%) and maternity unit (67%), with frequent stock-outs of intravenous solusets and pediatric electrodes. Supply bottlenecks included delayed deliveries from the Kenya Medical Supplies Authority (51-60% order fulfillment) and reliance on manual inventory systems. Only 22.7% of staff had inventory management training, but trained departments showed significantly higher availability (p = 0.029). Supervisory oversight and forecasting tool use also influenced availability. CONCLUSION: tracer essential commodity availability at Kitui County Referral Hospital remains inadequate due to systemic supply chain inefficiencies and weak inventory management. Prioritizing staff training, digital inventory systems, and stronger supervision are actionable strategies to reduce stock-outs and support Kenya´s Universal Health Coverage goals.