Unmanned aerial vehicles, also known as drones, have become a hot topic in public health for their potential in delivering life-saving medicines, blood, or vaccines to people in remote areas. But much of the conversation is dominated by suppliers aiming to acquire market share for their latest products and services, and not enough comes from the perspective of health ministry officials, who have to make hard choices with little information. We would like to correct this imbalance by offering a guide to making informed decisions for improving health outcomes, and articulating some of the trade-offs involved.
To examine the potential for employing UAVs across a public health system, a team from the Bill & Melinda Gates Foundation, John Snow, Inc., Llamasoft, Inc., and the Nichols Group looked at UAV cost-effectiveness compared to a motorcycle-based system and other well-run forms of land transport, using three sets of data from African countries over 12 months. The underlying objective is to save and improve lives through more effective service delivery.
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Our intent was to create a tool for health officials to use when engaging in discussions with UAV manufacturers and making investment decisions. We feel that the global and country dialogue needs to be expanded to include considerations of the biggest drivers of cost-effectiveness, and ways to redesign health systems that will optimize service levels. Our next step is to test our approach and prototype tool by working closely with health ministries in three to five countries, starting in Tanzania.
In the meantime, we would like to share high-level guidance to approaching this important decision. In determining how to integrate UAVs into a transportation fleet, we suggest decision makers follow a series of steps so they can make informed decisions. The three most important elements that affect the decision to invest are the priority health objectives — which determines the product and demand — geography, and the characteristics of the UAV itself.
The first step is to articulate which of the following interventions are a priority and most relevant to achieving overall health goals or impact. Our analysis identified five areas where it might make good sense to use a UAV.
• Safe blood for transfusions
• Long-tail products (i.e. low volume products that have unpredictable demand, such as anti-venom for snakebite or rabies vaccines)
• Program and essential medicines (in response to stockouts)
• Diagnostic specimens
Each of these, or other, health interventions should then be assessed according to these four requirements, with the following questions:
• Speed/responsiveness: How urgent is the need?
• Availability: How predictable is the demand, and what is the damage from a stock out?
• Risk reduction: What is the risk of spoilage or expiry of the cargo? How difficult is storage in the last mile?
• Cost: What is the financial or health value of the product?
For example, can we afford to hold high-value commodities at peripheral storage sites with a risk of expiry or theft? Or do UAVs offer the opportunity to redesign the system to establish hubs that serve multiple facilities with more frequent, smaller deliveries on demand?
Next, ensure you have a clear understanding of the geography you are dealing with.
• What is the density of health facilities?
• How difficult is access by road?
• Is there room for a runway?
Then, taking into account all of the data above, select the type of vehicle that is most appropriate. Technology is rapidly improving, and product information is not readily available in one place, but it is important to explore with every manufacturer:
• What is the range of the vehicle? The speed? The size?
• What is the capacity of the load in terms of weight? Of volume?
• Is it fixed wing (for air-drops) or a multicopter (able to land, pick up specimens, and return)?
That’s when you start matching up need with product. For example, small, fixed-wing UAVs can offer both cost and responsiveness advantages over land transport to deliver rare or emergency blood types. We see the greatest potential value in using UAVs when all the following characteristics align: Life-saving products that have unpredictable demand and are difficult to store; high density of health facilities within UAV range; and difficulty in accessing them by road.
However, most UAVs are still at least three years away from being cost-competitive with optimally routed motorcycles. At this point, it is not cost-effective to deploy UAVs without identifying ways to increase flight frequency, thus helping to defray fixed costs faster. This can be done by using UAVs across multiple health interventions and products, sharing them with non-health deliveries, or focusing on denser population areas. The cost-effectiveness will certainly improve over time as technology evolves.
It is also important to look at total system costs, such as inventory and capital investment for storage capacity, rather than transport alone. The decision whether to purchase UAVs offers the opportunity for a strategic system redesign that can optimize service levels while considering costs. And of course, money is not the only concern of supply chains. Speed, availability, and broader health benefits matter too, especially when it comes to opportunities for saving lives. A mother turned away without her contraceptives or a vaccine for her child impacts more than her family’s immediate health. There can be a ripple effect from stock outs if this experience discourages her from coming back.
Our aim is to ensure countries are in the driver’s seat for deciding when and how to invest in UAVs. Health professionals should be able to shape decisions based on their own priorities, and use evidence that relates to their specific health objectives and budgets.