Efforts to Use Drones to Provide Healthcare Yield Mixed Results

By Will Boggs MD

August 20, 2019

NEW YORK (Reuters Health) - Bidirectional transport drones, which can land in a remote health facility or village and return, have been employed with mixed success in the healthcare programs of Madagascar, Malawi and Senegal.

"Successes have been achieved on the windy road to final integration of drone flights into the supply chain of health systems in sub-Saharan Africa," said Dr. Astrid M. Knoblauch from Institut Pasteur de Madagascar, in Antananarivo, and the Swiss Tropical and Public Health Institute, in Basel, Switzerland.

"Enabling regulatory environments, favorable drone testing environments and, not least, successful pilot flights are examples," Dr. Knoblauch, also at Stony Brook University in New York, told Reuters Health by email.

Bidirectional drones have the potential to support supply chains, emergency responses, disease prevention, deployment of networks for data harvesting in unconnected areas, and health research.

Dr. Knoblauch's team describe the regulatory, technical, and operational aspects of projects in three sub-Saharan African countries in a report online July 30 in BMJ Global Health.

In Madagascar, drone technology was explored as a way of enhancing tuberculosis care by flying sputum samples and medication for diagnosis and treatment between a centralized, well-equipped laboratory and remote villages in one district.

Proof of concept was achieved with drones successfully transporting dummy payloads, to the extent that the Malagasy government, major health-service providers and funders plan to integrate drones into their health-provision activities in Madagascar.

Major obstacles to the Madagascar effort included the lack of drone-specific flight regulations, the necessity of switching the drone technology due to the provider's inability to deliver functional drones, and the subsequent unavailability of a technology solution for use in real-world conditions of remote Madagascar.

Two bidirectional drone transport projects in Malawi are currently dealing with a variety of regulatory and operational issues. One UNICEF effort to use drones to facilitate the transport of dried blood spots for early infant diagnosis of HIV found it cheaper to use motorcycles.

A second project that tested the feasibility of using drones to transport blood and injectable oxytocin for obstetrical emergencies had to terminate test flights due to GPS interference from cellular towers.

Senegal is assessing the usefulness, health impact and cost-effectiveness of drones for transporting laboratory samples for diagnostic tests, delivering treatment for medical emergencies, and delivering essential medicines and medical supplies when needed between routine supply trips.

So far, the provider has failed to demonstrate autonomous flights between the base and designated destinations as well as successful "return to home" functions. This project is currently seeking additional resources to enable another drone provider to receive flight authorization, which will allow operations to begin.

The authors suggest that successful future efforts will require "(1) developing more reliable technologies, (2) thorough vetting of drone providers' capabilities during the selection process, (3) using and strengthening local capacity, (4) building in-country markets and businesses to maintain drone operations locally, (5) coordinating efforts among all stakeholders under government leadership, (6) implementing and identifying funding for long-term projects beyond pilots, and (7) evaluating impacts via standardized indicators."

"It needs to be recognized that the journey is half the reward and an absolute necessity," Dr. Knoblauch said. "The starting point was a brilliant idea with an existing but untested product that was not ready to use in the settings it would be most impactful. Biosafety, regulatory, technical and importantly, community-based aspects are pivotal issues to address along this journey without which the goal of integrating drones routinely into health systems cannot be achieved."

"As every product, the drones go through an iterative development process," she said. "A lean product-development process could accelerate development of a ready-to-use drone in a sub-Saharan African setting."

Dr. Knoblauch added, "I hope that physicians come to appreciate the potential of this technology, in their own working environments and especially in environments where their colleagues constantly struggle with stock-outs of medical equipment, diagnostics, and treatments."

"Physicians will have an important voice in determining the use case of medical drones," she concluded. "While technology companies and public-health providers want to be on the forefront of innovation, health workers, as final users, must sit on the table to define clear needs. Being the last link between the health system and the patient, they have a role in ensuring that the technology serves best the population in need while not increasing their work-load."

Dr. Manohari Balasingam from Kajang Hospital in Malaysia, who recently reviewed the rising use of drones in medicine, told Reuters Health by email, "We definitely need a coordinated effort to get this piece of technology in the air. For a start, these applications face challenges such as national legislations, climate zones and topography, medicolegal and licensure issues, finance and reimbursement, as well as community attitudes and acceptance in different nations."

"The stakeholders need to come to the table - healthcare workers, drone manufacturers, insurance companies, legislative authorities, and government bodies," she said. "Perhaps more drone conferences could be organized globally, to make more people aware and involved including the stakeholders. Drone courses and awareness programs could also be incorporated into medical, engineering, and IT conferences where a large number of industries are gathered."

"Transforming healthcare globally to achieve sustainable development goals as voiced by the World Health Organization would be our ultimate aim in medicine," said Dr. Balasingam, who was not involved in the new report.

SOURCE: https://bit.ly/2OVe1BR

BMJ Global Health 2019.