Flying medicines over mountains in Nepal
An account of our Sprint
Our dream of flying comes with a prelude — a trek!
“Drones aren’t new” we had said previously, and this is an established fact. Our intention was not to test if medical drone technology is of value in the health sector, but to see if it is possible to design a medical drone intervention that is fully owned by the Government of Nepal and can be embedded in the health system.
Our approach to this was (and is) to enable action that is evidence based, builds local capacities and draws on the right global expertise at the right time. The journey towards our destination through two Sprints so far has been interesting and productive, but not without pitstops along the way. Much like traversing the enchanting yet challenging circuitous routes of Nepal’s hills and mountains, our work journey too has paused for deep breaths, but only to be re-invigorated by the view we had and keen and enterprising stakeholders.
Public and private — where shall the twain meet?
Consultations and conversations with a number of people who deeply understand Nepal’s health sector and the dilemmas a developing country government faces emphasised one inalienable truth — the fiscal space within government budgets to undertake a medical drone venture at scale would be small. The question before us therefore was not — ‘Can the government implement a drones initiative?’ but ‘Should the government implement or manage?’ We had already engaged with the Ministry of Health and Population who had clearly shown an inclination towards exploring the ‘end-user, service-buyer’ model where they envisaged that the government would only buy services from a drone operator. To kickstart the thinking, we organised a multi-stakeholder consultation meeting in Kathmandu. The meeting was the first of its kind, bringing together all operators and innovators working on drones for development, and government stakeholders, to explore how they could be used in the health sector to reach last-mile communities.
Senior-most officials from the Ministry and its various Divisions sat at the same table with private sector drone operators in Nepal to understand each other’s concerns and needs. There was overwhelming agreement that the time was ripe to introduce the use of medical drones in Nepal. The country now has a federal system of governance and local municipalities are keen to see their constituencies develop and prosper. With oversight from the federal government, a solution for making health services comprehensive and improving them in remote and hard to reach locations could be found if the private sector was willing to step in to respond to the need. The COVID-19 pandemic had also sent home a strong message that technology could be an enabler when emergencies hit us.
We also learnt from a project that used bi-directional drones to carry sputum samples and medical reports in Pyuthan district — a fairly hilly terrain. We agreed on all this and mulled over what lay next. The path covered so far, was far from easy but looking ahead we saw a steeper incline and a ‘गोरेटो/goreto’ (goat track in Nepali) to take us further.
Drone operators around the table included those who had successfully used drones for various purposes — spraying pesticides, mapping terrains, photography and so on. They were willing to try using them in the health sector too. But there were concerns — navigating government regulatory needs has been a challenge! Obtaining approvals for developing, testing and operating drones in Nepal was not easy, they said, due to the administrative and legal requirements. These concerns were allayed by the Ministry officials. They were committed to seeing progress in the health sector and were willing to support the private sector to navigate and fulfil the administrative processes for operating drones in Nepal. They hoped to be the ‘end users’ of the technology and were willing to develop an effective partnership with local drone operators. But the government officials had some concerns and questions too.
Could the private sector rise to the occasion to suggest a ‘workable proposal’? Did they have the technical capacity and readiness to make drones that could address local needs? They had flown drones of course, but were these suitable for mountains in Nepal that could be no less than 4000 metres high? And if they were, what would it cost to fly the drone in these regions? Was it sustainable for the government and was the private sector incentivised enough? Would a multi-purpose drone model that served other needs beyond the health sector in these remote areas help with financial sustainability? What would such an operating model look like?
Questions aplenty, implied work aplenty!
Local contexts, local needs and local participation
While deliberating with the drone operators was one aspect, identifying locations where drone services would be suitable was another job. Government officials were now keen to explore where drones could be flown. Along with a team of senior officials from the Ministry, we travelled north-west to East Rukum — a mountain district. The district is divided into three rural municipalities- Bhume, Putha Uttarganga and Sisne. The elevation reaches 6,000 meters in the Dhaulagiri region, and the climate ranges from sub-tropical in the relatively lower areas to perpetual snow and ice in the higher regions. We needed to know what the specific local health needs are and which drones were best suited to address them. The Ministry also needed to know if the local Mayors were interested in investing in medical drones.
Our first port of call was the Provincial Health Office (previously the District Health Office prior to federalism) where we invited elected officials from the three municipalities, municipal office senior staff including the health section staff, facility level health workers, and authorities from the District Education Office for a discussion to understand local needs and to gauge political appetite for medical drones. Discussions focused on challenges with supply chain and stock levels, transportation for medical supplies, and the potential of drones to address local challenges. The local stakeholders evinced a keen interest in the drones and agreed that new technology could resolve certain problems. They felt an ‘integrated’ approach to implementing any project was needed which enabled as well as strengthened exchange and collaboration with other sectors like education, agriculture within each municipality and with neighboring municipalities. Could drones meet this challenge?
Fit for purpose?
This Sprint highlighted the government’s main concerns about the drone’s technical, operational and financial feasibility and sustainability. So, the technology may not be new and drones may have flown miles saving lives in other contexts, but is our proposed solution fit for purpose in Nepal?
We quickly realised the federal government would need a tool that it could use to do a first level selection of districts where drone operations could add value to the health sector. This has led us to develop a framework that allows multi-parameter analysis of each region e.g. topography and accessibility. Our field-level data gathering was to test this multi-parameter framework. We talked to Mayors, Health Section Chiefs and health providers across local municipalities and selected facilities in two remote and mountainous districts of Nepal — East Rukum and Humla. Our initial analysis shows that two districts had different needs despite similarities. The districts potentially therefore need different models of drone operations for reaching areas and facilities, based on size, number of municipalities, number of facilities, and other factors. We are working through the numbers and quotes and toying with ideas, even as we continue conversations and consultations at the federal level with government and the private drone operators.
We have learnt so far the importance of involving government stakeholders every step of the way — from thrashing out the initial concept, to visiting potential areas of implementation, to unpacking questions, concerns and emerging findings together. The fact that we are already well connected and established within the health sector has helped tremendously! We have also learnt the importance of being adaptive to change, as our focus and direction has shifted over time, based on discussions with stakeholders and learning as we go.
Although embedding drones within the Nepal health sector is not yet assured, we have taken positive steps in that direction. We are delighted! The federal government was keen, the local municipalities are interested. But is the attraction strong enough for the private sector? Is the right technology available in Nepal? How can we ensure not just political, but also technical sustainability? Here starts the next lap of our trek…sorry Sprint! We hope to present a workable proposal to the government based on what we learn in the coming few weeks.
Blogpost by the Options and NFL team
