In remote regions of Malawi, terrain, infrastructure, and resource limitations delay — and can even prevent — lifesaving diagnoses and medicine deliveries to hospitals and health centers. Similar obstacles exist in countries across the developing world and the global health community is starting to turn to drones to speed up and bring consistency to the delivery of critical health commodities and health care services.
In theory, drones should help counter health supply-chain challenges in remote regions across the globe as costs go down and the technology becomes more affordable. But can this technology be effectively integrated into existing health supply-chains? Will it improve health outcomes? What are operational considerations, and how will communities interact with it?
In an attempt to answer these critical questions, the U.S. Agency for International Development Global Health Supply Chain Program-Procurement and Supply Management, or GHSC-PSM, project is seeking to understand what it would take to move laboratory samples and results reliably — and in a more predictable timeframe — and to deliver emergency medical supplies to places that would not otherwise receive them on time.
To add value, drones must integrate the existing supply-chains and distribution channels rather than operate in isolation or in parallel.—
While GHSC-PSM has a ground presence in more than 30 countries, it chose Malawi for piloting cargo drones as a last-mile delivery solution for the country’s health supply-chain because the government has launched a drone corridor — an air space for safely testing drones in remote areas — and instituted a transparent process for issuing approvals for drone operations.
Since July 2019, the project’s drone, funded by the President's Emergency Plan for AIDS Relief, has been running daily cargo flights between Nkhata Bay District Hospital on the lakeshore and St. Peter’s hospital on Likoma Island. It ferries critical health commodities and patient samples back and forth, shortening transportation times by weeks, and ensuring samples are processed and results shared with clinicians in due time. The project has just added St. Mary’s, a small health care facility on Chizimulu Island, as a second origin/destination site and is now assessing other isolated sites along the shores of Lake Malawi, permanently cut off from road access.
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Since routine flights began, the GHSC-PSM cargo drone has flown 2,626 cumulative miles and transported the lab results of 130 patients, reliably delivering diagnosis and treatment eight weeks earlier than the past lead time. GHSC-PSM has completed 56 cargo flights just in the last three months, transporting more than 100 viral load, early infant diagnosis and tuberculosis samples for testing, as well as micropipettes for HIV testing, emergency medicines, vaccines, and syphilis test kits.
What makes this drone effort distinctive and worth watching is the breadth and depth of in-country collaboration to ensure its effectiveness and document lessons that can only be learned over time. Many development cargo drone pilots run for one or two weeks — too short to track considerations such as improvement to health outcomes, maintenance costs, long-term training, upskilling, and knowledge transfer. Unlike short-term pilots, sustained bidirectional flights require intimate knowledge of the in-country health system and supply chain, including the subsystems for lab referrals and reporting.
As the drone flies over Lake Malawi — more than a hundred miles each day — carrying lab results and medical cargo, the project gathers valuable information that leads to a better understanding of the impact of drones on health outcomes and of what it takes to operate cargo drones over a sustained period of time.
GHSC-PSM is seeking answers to questions that will be critical to understanding how drones add value to health supply-chains in low-resource settings:
1. How can drones be used as a tool to improve health outcomes?
Before GHSC-PSM started the drone activity, local hospital staff were absent from their health facilities for at least a week to drop off lab samples and obtain sample results, which took them away from their primary care provision roles. Drones now reach these locations in under an hour, saving time and resources, facilitating lab sample processing, providing result return, and mitigating stockouts of emergency supplies.
Without the drone, lab samples from the islands in Lake Malawi may wait at St Peter’s Hospital for up to two weeks before being picked up and transported by boat to the Nkhata Bay District Hospital on the mainland for processing. The results could then take up to eight weeks to return to the islands, delaying diagnosis and treatment. Even then, nearly half the results never made it back because the samples or the results were lost in surface transport, and the amount of elapsed time made patient monitoring largely ineffective.
2. How can drones fit into an existing health supply-chain?
To add value, drones must integrate the existing supply-chains and distribution channels rather than operate in isolation or in parallel. This means that drones need to operate where supplies are stored and samples are collected, as well as where they are used — or in this case, where samples are received and test results generated.
The drone launches from the Nkhata Bay District Hospital in Malawi, allowing pharmacy and laboratory staff to participate in the operations on a day-to-day basis. At the smaller and more remote Chizimulu health post, the project team trained local staff at Likoma Island in drone flying, proper loading and unloading, communications procedures, and securing the landing area, so local staff are fully capable of receiving and dispatching the drone without assistance.
3. How do we coordinate among health staff?
The drone activity has required GHSC-PSM in Malawi to closely collaborate with hospital staff to create new communications protocols between the requesting and sending facilities as well as with the flight operations team. Before each flight, pharmacy and lab technicians communicate through a WhatsApp group. If either of the island facilities is sending samples for testing, a qualified lab technician from the Nkhata Bay District Hospital will meet with the flight operations team to receive the cargo.
Similarly, hospital staff signal when needed medicines are available so that the receiving facility knows what to expect and when to expect it. This written record of flights and requests is an important supplement to regular documentation of inventory flows. The project also works within the existing supply chain so that the drones don’t leapfrog over important hubs where medicines or samples normally flow for collection and/or processing.
4. How do we connect with the community?
A flying object — bigger than a bird, but much smaller than an airplane — has the potential to confuse residents and raise concern in remote villages. GHSC-PSM worked with the Malawi Ministry of Information and Communications Technology and UNICEF to carry out community sensitization activities, which spanned radio public service announcements, public demonstrations, and question and answer sessions.
However, public sensitization activities alone cannot replace the in-person opportunities to safely view the operations in action. Drone flight personnel must be available to facilitate interactions with the public and should select takeoff and landing sites strategically to facilitate crowd control.
The GHSC-PSM project has had sustained bidirectional flights now over several months, and these will continue through the end of the year, which provides a relatively long-term opportunity to assess what the activity has accomplished and answers questions about the costs and benefits, operational considerations and programmatic impacts of integrating drones into a public health supply-chain.
Two years ago, as the project began investigating the possibilities of integrating drones into health supply-chains, the project developed and shared a drone procurement guide with the wider development community. The project will share its drone feasibility and readiness assessment guide by the end of the year to help interested stakeholders home in on the greatest potentials for impact, as well as to identify areas of concern where more work may be needed to pave the way for drone innovations The project will share any lessons learned publicly so others can leverage them for their own drone operations.