Flying medicines over mountains in Nepal
Communication, Co-ordination and Coherence across stakeholders is key for action
Drones have now become almost ubiquitous — from delivering your packages to taking cinematic shots — they have penetrated daily lives in many ways. And in the recent times with the growing use of artificial intelligence (AI), the marriage of drones and AI technology seems to be breaking new barriers. On the flip side, it is these very technologies have also triggered concerns about misuse and the need for adequate regulations being in place. Our previous blogposts had referred to our aim to understand the landscape in Nepal for drone operations. In the first sprint, we undertook a feasibility study to understand the stockout of medical supplies, identify locations where drones could help solve supply chain challenges to reach the last mile, and shortlist locations for drone deployment. In the second sprint, we held a multi-stakeholder consultation meeting with government stakeholders to brainstorm potential drone deployment and unpack stakeholders’ questions and concerns. In our third sprint, we arrived at the humbling conclusion that drone operations depend on a complex ecosystem and the health sector cannot be the only entry point. Below is an account of our third sprint and some takeaway messages.
The previous sprints had helped to answer some questions but more emerged — such as, which health facilities needed drone operations? How would a drone work in various terrains? How much would a drone delivery programme cost? We then delved into researching these issues in the Nepal context.
Finding the right health centres
We tackled the first question by trying to identify parameters that would help select locations and health centres for drone deployment. There were several factors that had to be considered in terms of the Nepal mountains — from road accessibility to elevation — that would determine whether it would appropriate to deploy drones in a particular location. Our teams took an evidence-based approach and consultations with government and health system stakeholders to draft a list of parameters that can also be used in other countries with similar socio-economic and geographic contexts. We gathered data on roads, accessibility, topography, and health facilities, patient density identified potential health facilities in East Rukum and Humla districts in Lumbini and Karnali provinces where drones could be flown.
Estimating costs
We built a cost model, based on data gathered from actual costs of past projects and through interviews with local stakeholders. We modelled this as district wide project for scale and based it on our estimates for Humla but allowing for the scope to adjust the cost model to other districts or if scaling up the project. The cost model analysis indicated that importing a drone would be the single-most factor that would increase the costs significantly. Our estimates also showed that if a drone were to be used up to 5 years, the average cost of each drone delivery would be approximately 1400 Nepali Rupees (10 USD) over the five years, and this could be much lower if locally or regionally manufactured drones were to be used. This only indicated that to help drive down costs, it was necessary to have a strong local private sector that is well supported good policies from the government.
Bringing diverse voices together
Armed with a better sense of where to locate drones, and what it would costs to fly a drone we shared this information with national and international stakeholders. For a second time around, in our work so far we brought everyone to the table and convened a workshop with international medical drone operators, Government of Nepal officials, local private sector drone partners, and the media. The workshop brought together 61 people representing 36 organisations for an energetic discussion on how a sustainable drone initiative could be undertaken in Nepal. It clearly emerged from the discussions that given the federal context the first action needed was to create an enabling environment for drone operations. With the Ministry of Home Affairs, Civil Aviation Authority of Nepal, the Ministry of Health and Population, and Nepal Academy of Science and Technology all as active participants in the workshop it was clear that a collaborative mechanism that would allow all of them to work together to progress on the drones agenda was important. It was also evident that if the drone technology had to be adopted for medical deliveries in remote locations, it was essential that the regulatory mechanisms had to be up-to-date, and the private sector had to be develop their offer through reliable and affordable services. The cost model shared by Options and Nepal Flying Labs had factored in a modest profit margin for the private sector operations with a view that the Ministry of Health and Population would be an ‘end-user, service-buyer’. However, under this needed further discussions whether there was the fiscal space within the government to adopt it in the future, and what the governance arrangements would be.
Official from Nepal’s Ministry of Health and Population highlighted the value new technology would add to improve the current status of healthcare provision in the country.
What we learnt
Developing an initiative that is yet to be tested or piloted, in partnership with multiple stakeholders and with the government in the driving seat, needs considerable investment in time and efforts. It is particularly important to note that navigating a complex devolved governance system, where changes in leadership affect the type of expectations require strong relationships and linkages with the government system.
A capital investment heavy initiative such as drones, is potentially better suited as a privately led initiative in Nepal wherein the government can only be one of the ‘client/buyer’ rather than planning this as one that is fully designed and operated by the government.
· Conversations within the Government — across Ministries — are essential as each of them are un-informed about specific policies, regulations (or the lack of them) or strategies that might have an influence on their plans and initiatives. There is a clear need for cross-ministerial information sharing and co-ordination.
· The private sector in Nepal for drones operations is still nascent and needs external investments into building their capacities. A complete scoping of the potential markets for private drones operations is needed which might help tailor some of the investments in manner that is most suitable. The potential for domestic resource mobilisation appears to be low as of now.
· Drones have to be complementary to the current supply-chain transport system and may not be able to (and should not) replace existing systems in Nepal given current circumstances. The drone initiatives have to be tailored to each individual district-level context due to the large variations seen between them. This would also mean that any proper production/manufacturing of drones should happen only after robust testing has been done in these environmental settings.
Moving forward a network of stakeholders from within the government and the private sector who have an interest in drone operations could help to plan, implement and regulate drones in Nepal. International experiences shared at the workshop, helped to drive home the key message that drones are working for the health sector in other countries and they can in Nepal too! Our contribution through our work on the selection parameters and costing helped to move the conversation forward a few more steps but those journeying towards implementing a medical drones project in Nepal, are yet to reach their destination.
