Flying medicines over mountains in Nepal
The data conundrum for a drone innovation
In Nepal, people’s access to health depends on where they live. Nearly 40% of the population live in hill and mountain regions that cover about 70% of the country’s geography. It is left to people or animals to carry essential medicines to remote areas, a journey that takes hours as this 3-minute video shows.
We know that drones have been used in many different countries to deliver health treatments, medicines, vaccines, blood and lab samples. While drones have already been used in Nepal in sectors such as surveying and mapping, agriculture and health, many health facilities in rural areas of the country still grapple with inadequate infrastructure, human resources, and medical supplies.
Having worked towards strengthening Nepal’s health system for over 20 years, our team at Options came up with the idea, partnering with the Government, Nepal Flying Labs and WeRobotics, to use drones in delivering life-saving medicines to reach mothers, newborns, and children living in remote areas. Our partners had previously implemented a multiple international award-winning initiative in Nepal to deliver sputum samples for tuberculosis (TB) diagnosis which showed promising results.
Drones could be a medium that connects health facilities in remotest locations to better-equipped facilities at the district centre or other areas so that costly resources do not need to be managed at all locations.
So you may wonder, if drones aren’t new, then what’s the innovation? Our solution is to directly address a key challenge many other drone initiatives face and have not succeeded at — achieving sustainable scale by integrating drones within the health system of Nepal.
To do this, we are first undertaking a feasibility assessment to better understand the reasons for stockouts of medical supplies and their impact on the health of women and children. We are also working with the Federal Ministry of Health and Population to identify locations where drones would help solve supply chain challenges to reach last mile communities by examining roles of government in key points of the supply chain and using this information to shortlist locations which are suitable for drone deployment.
Knitting the data together
Data from our Nepal Health Sector Support Programme showed disparities in access to key maternal, newborn and child health medicines and commodities for those living in mountainous areas. An analysis from an MIT study published in 2021 helped us identify suitable districts in Nepal that could benefit from drones to improve access to vaccines. Both these data sets were pivotal in understanding health needs but also the suitability of locations. However, we needed more insights on the functioning of the health supply chain from the federal level to palikas (lowest level of administration) and see at what points drones could complement and fill a gap in the existing supply chain.
We came across an information roadblock: different people at different levels of the health system had various pieces of knowledge on the health supply chain. We understand why this is the case. Nepal is in the process of decentralisation and roles and responsibilities are still being worked out within the health system, including financing and decision-making on procuring health commodities at various levels.
Some medicines and supplies, such as family planning commodities and HIV and TB treatments are procured directly at federal level and sent to provinces, and then palikas. In other cases, palikas procure products from within or outside their province (e.g. mainly maternal, newborn and child health products). Some provinces directly purchase these products from national and private sector suppliers. We found that different threads of information were there, but not coming together as a whole. So, we pivoted to a bottom-up approach, focusing our analysis in a couple of provinces rather than the whole country.
Our analysis covers information on geographical factors such as slope, surface and elevation as well as road accessibility to identify if selected are suitable for drone deliveries. We will combine this with population data, number and spread of health facilities and health service indicators such as deliveries and stocks of medicines in these areas to identify need. By stitching together the various threads of information gathered during the feasibility assessment, we hope to make a wider contribution to understanding the health supply chain in Nepal.
The direction of travel
The various data sources we have looked at, including from routine government health information, NHSSP programme results, evaluations from non-government health programmes as well as stakeholder interviews, have pointed us in different directions with regards to the challenges in getting essential lifesaving medicines to people living in remote rural areas. Unravelling the complexity of these issues has given us a nuanced understanding that stock-outs may be the combined result of a number of bottlenecks, such as procurement processes, costs of medicines, limited storage infrastructure and transport.
Our aim is to hone in on areas where transport challenges are most likely to be pronounced. We will then investigate catchment populations and use that as a basis to determine whether stock supplies at facility and palika levels in selected provinces meet anticipated health needs of the population. The government had coincidently and to our luck disseminated a list of drugs, known as the Basic Health Services List, that each level in the health system is expected to procure. This will be additional thread of information that will be feed into our analysis.
Finding a home
We engaged and co-created with government counterparts the idea to embed drones into the health system in 2020. We shared the latest information gathered from the feasibility assessment with the government’s Policy Coordination Committee (PCC), which is the highest body within the Ministry of Health and Population for policy issues. Given that drone initiatives in Nepal so far have been sporadic and project-based, the PCC appreciated the concept of embedding the drone in the health system. The government expressed the need to focus on making the innovation sustainable and a willingness to embed drones in the health system as an ‘end-user, the service-buyer’. The PCC’s acceptance sets the foundation for institutionalising our concept within the health system with government stewarding the innovation.
Our next sprint will drill down into health and topography data in two districts to see if they would benefit from medical drones. We will also learn more about opportunities to leverage private sector involvement in drones work and work with partners to understand the cost of using drones. All this data combined with information gathered through this existing sprint will move us closer to embedding drones within Nepal’s health system and contribute to achieving universal health coverage for all.
