Drones can strengthen delivery of health supplies, a new study finds

Drones have the potential to strengthen public health supply chains and improve the availability of medical products, according to a study in Ghana on the impact of Zipline, which uses drones to deliver medical supplies.

The independent study demonstrates how the company’s “instant logistics” system has addressed health supply chain challenges in the country. For example, it has increased the diversity of products stocked in the medical facilities it serves and reduced stockouts of medical products and vaccines.

The data from Ghana points to the potential for drones to deliver health products such as medicines and vaccines in other countries and areas that have weak distribution infrastructure.

Most health supply chains send products to facilities to ensure they don’t have stock shortages, said Pedro Kremer, Zipline’s impact evaluation lead.

“The system is really inefficient,” he said at a Center for Global Development event last week where the data was presented. “It results in a lot of waste and expiration.”

That’s where drones may be able to help. Zipline delivers shipments to ensure that products reach facilities at the exact time they are needed, Kremer said. It warehouses products and processes orders placed by general health care workers and other customers, as well as medical stocking orders, via text, mobile, or web app, Kremer said.

Due in part to a lack of systematic evidence on drones’ value for health product delivery, there is a lot of skepticism around their feasibility and cost-effectiveness.

But the study — which was conducted by IDinsight, an advisory, data analytics, and research organization, with funding from the Bill & Melinda Gates Foundation — validated Zipline’s statistically significant impact on commodity availability, supply chain performance, and health impact. It compared outcomes between treatment facilities, those within Zipline service zones, and control sites, collecting data between October 2019 and October 2021. The final sample included 107 treatment and 112 control facilities.

Zipline’s service decreased the number of days that facilities were without critical medical supplies by 21%. It shortened vaccine stockouts by 60% and decreased people being turned down for vaccinations due to issues with inventory by 42%. Zipline’s service also increased the types of medicines and supplies that were stocked at health facilities by 10%.

This data reveals how drones might be part of the solution to inventory management and other supply chain challenges. While Zipline is the dominant player in drone cargo delivery of health supplies, the technology is maturing, the industry is growing, and these findings highlight the potential for drones to deliver health products in near-real time, said Prashant Yadav, a senior fellow at CGD and an expert on health care supply chains.

Zipline’s work in Ghana

Zipline began working with the government of Ghana in 2019. At the time, Zipline had already worked with IDinsight to develop an impact evaluation plan. The Silicon Valley-based company was expanding from Rwanda, where it started delivering blood products in 2016.

Today, Zipline has six distribution centers in Ghana that reach 2,300 facilities, and it has partnered with Ghana’s Health Ministry to deliver a range of essential medical products, including 1 million COVID-19 vaccines.

Because the Zipline infrastructure was already in place when the pandemic began, Ghana’s health service was able to use these drones as part of its COVID-19 response. Two-thirds of the COVID-19 vaccines that Zipline has distributed in Ghana are one month away from expiration, Kremer told Devex.

“While countries across Africa have had to reject COVID vaccines because they are too close to their expiration date, Ghana is taking them — saying, ‘Bring them here’ — because of Zipline,” he said.

One-third of the time, missed opportunities for vaccination are related to stockouts, Kremer said, and by improving the stock of COVID-19 vaccines, Zipline reduced these instances.

Zipline’s model aligns with Ghana’s unique definition of universal health coverage, in which Ghanaians have “timely access to high-quality health services, irrespective of their ability to pay at the point of use,” said Emmanuel Ankrah Odame, director of policy planning at Ghana’s Health Ministry, during the CGD event.

Ghana’s government has included Zipline in its five-year Supply Chain Master Plan, which calls for strong supply chain systems to more effectively manage health commodities, Odame added.

The country has also included Zipline in its “Ghana Beyond Aid” vision, which aims to reduce dependence on donor aid, said Caitlin Burton, Zipline’s vice president of global health partnerships. The company is contracted to launch with Nigeria, Kenya, and Côte d'Ivoire in the next six months.

“By the end of the year, we’ll be within 45 minutes of 45 million people in Africa,” Burton said, meaning Zipline will reach over 3% of the continent’s population of nearly 1.4 billion people.

Increasingly, Zipline is focused on partnering directly with national governments, she said. The company sees this approach as key to going to scale. In the past, Zipline has partnered with development organizations conducting pilots, but this fixation on specific use cases for drones held the sector back, Burton said.

“It was really only through these government partnerships — where the use-case development is very organic and locally led and responsive to whatever a health system needs — that we’ve gotten to learn a lot,” she said. “And so we see a shift now in moving beyond working with the governments to also increasingly [working] with development actors that are really focused on large-scale health access.”

‘At the end of the day, it’s a tool’

Still, many global health leaders remain skeptical of whether drone technology can go mainstream in health delivery.

“At the end of the day, it’s a tool,” said Muhammad Ali Pate, a professor of public health leadership at Harvard University who has served as Nigeria’s health minister, CEO at Big Win Philanthropy, and global director for health, nutrition, and population at the World Bank Group.

Drones seem more suited to deliver a niche set of products needed on an emergency basis, he said during the event. Nigeria has 37,000 health facilities, Pate said, and governments have to ask whether drones are “the most cost-effective tool for [the] health system to use,” as compared with other options.

Pate also noted how people, including health care workers, are critical in ensuring this delivery technology results in significant improvement in health outcomes.

The study offers some insight into this. For example, just 14% to 34% of health care workers are instructed to use Zipline to resolve stockouts, and there is some confusion over when and how to use the service.

There is an opportunity for more impact with greater uptake. Valentina Brailovskaya, an associate director at IDinsight, highlighted the importance of engaging with health care facilities, conducting interviews, and understanding what might prevent facilities from using the Zipline service.

The results from Ghana serve as a preview of further work that Zipline plans to do in impact evaluation, Kremer told Devex.

“We don’t want to be conducting retrospective impact evaluations all the time,” he said. “We want to have something closer to a sustained monitoring system.”

Zipline collects data on supply chains, and how much the company flies, stores, and delivers, but increasingly it will look to governments for data on associated health outcomes, Kremer said.