Medical Cargo Drone Delivery

One of the greatest challenges to improve rural healthcare is the transport of clinical samples, access to medical devices for diagnosis and delivery of medications. On average, it takes 6-8 hours to travel between a hospital and a healthcare facility in rural Nepal. The fact that UAS are far less time consuming than the time required to travel by foot or through dangerous winding roads in mountains not only serves to reduce additional consequences, but have the added advantage of increasing resilience and preparedness in case of emergencies. Therefore, our drone technology in drone optimized therapy system (DrOTS) links rural-health-posts with high-end GeneXpert diagnostic tools via-drones with the main aim to improve the accessibility of diagnostic tests. This way it helps change lives as drones can now transport their sputum samples in a very short time without having them visit the doctors.

Globally, more than one billion people lack access to all-weather roads. This lack of infrastructure has a direct impact on health outcomes, especially when disasters strike. When inhabitants of such areas become ill they must run a gauntlet of challenges on their pathway to care. These include arduous walks to reach health clinics, health facilities staffed by poorly trained health workers equipped with limited diagnostic tests, and a need to return frequently for continued health monitoring. There are substantial discrepancies in access to healthcare between urban and rural residents, particularly in low and middle income countries like Nepal with fragile infrastructure and limited skilled human resources for healthcare. It is a known fact that more than 80 percent of Nepalese population live in rural areas among which 50% are living in mountainous and hilly region of the country with poor access to healthcare.  It takes more than 6 hours to travel between a house and proper healthcare facility in rural Nepal. On top of that the density of qualified physicians in the country is 0.74 per 1000 people. People are dying from simple diseases due to remoteness of villages and health facilities are not easily accessible. 

Under our medical cargo drone delivery system, drones fly from the central district hospital to health posts in remote villages and bring back sputum samples for diagnosis.  In Pyuthan district of Nepal, DrOTS uses our drone transport network to improve access to the most advanced diagnostic testing for tuberculosis (TB), and to remote treatment adherence monitoring (e-DOTS) using electronic pill boxes (Wisepill Technologies, South Africa). The major objectives of the project include were as follows: 

1. To Establish an “On-Demand” Drone Service in the mountainous/hilly area including an appropriately equipped and staffed base camp and a cadre of health workers who were able to request a drone when required with easy-to-use system for operating the drone flights.
2. To Remotely Diagnose TB – This same cadre of health workers were trained to recognize a person likely to have TB according to the norms of the National TB Program, explained to them the need for testing and safely obtained quality sputum samples.
3. To Remotely Observe TB Therapy – By combining conventional health provider interaction and innovative technologies, patients were monitored over the six-month treatment for adverse drug reactions, ensured medication adherence and assessed trends in symptoms.

There are two major stakeholders served by this solution and the project: Patients in rural areas and Healthcare personnel. In case of Tuberculosis, most patients are either the elderly or young children. It is very tiring and time consuming for them to visit a hospital each day to take medicines and also to get their samples tested. The project directly helped these stakeholders because drones can now transport their sputum samples in a very short time without having them visit the doctors. Also, patients can take medicines regularly and remind themselves the right time for medicine intake using the smart pill box.

The project is following a sustainable approach in terms of operations. The majority of medical drone projects around the world are operated in developing and emerging nations but managed and handled by foreign experts. The unique aspect of the DrOTS project is that it is completely handled by local experts who were initially empowered with technical training from international experts. This provided opportunities for local people in Nepal to be engaged in a challenging and first of its kind project in rural healthcare like DrOTS.

To be truly sustainable and integrated, the cargo drone technology was operated and maintained by rural healthcare personnel who often have a limited formal education and many competing demands on their time, which is a distinct proposition from a commercial drone network operating for profit. This included development of simplified Standard Operational Procedure (SOPs), protocols for flight operation, including fly/no-fly weather criteria, validated training modules, robust and durable hardware and customized software. 

The biggest impact which this project has created is in terms of sensitizing the local government and the federal ministries in Nepal. Prior to this project, drones in healthcare were limited to a possible concept. Now, the consortium of several agencies including a healthcare partner have proved that with proper modifications and contextualization of existing tools, drones can be customized and used for rural healthcare activities in Nepal. This has helped us convince the ministry and people at a decision-making level to believe that drones can help the Ministry of Health and Population reach the most vulnerable population in a short time and with higher efficiency.

A cargo drone delivery system has been built that is centered around drones-as-a-service for sputum sample collection which can be implemented to other medical delivery services. Rapid diagnosis is very crucial for rapid response of disease outbreaks. The primary objective of this intervention was to enhance the easy connectivity between hospitals and rural healthcare centers, and to improve the accessibility of the rural population to basic healthcare facilities. With a cold chain enabled cargo box, this same system can be scaled as well as replicated to carry temperature sensitive medicines and vaccines too. 

Firstly, this project is the only project in the south-asian region where drones have been successfully implemented not just as pilot projects but for actual transportation of hundreds of samples of old and vulnerable population for the diagnosis of TB. Till date, we have conducted hundreds flights collecting 1915 sputum samples out of which 62 have been diagnosed as active TB cases. 

Secondly, this is a unique project in terms of partnership as the Ministry of Health and Population itself is in the leading partner to the project helping the project work together for the common goal of improving rural healthcare through the introduction of frontier technology. The drone flight is currently operations in two communities with precision landing for autonomous flights:

1. Pyuthan Municipality : District Hospital to its 4 rural health posts
2. Swargadwari Municipality:  Bhingri Healthcare Centre to its 4 rural healthposts 

The drone is cutting-edge technology which can efficiently intervene and aid better healthcare connectivity in rural locations around the world. We customized an easily available drone augmenting it with a cargo box as its payload which that could safely transport the medical samples, while at the same time allowing easy and fast loading and unloading of the samples. Hence, the engineering team designed and 3D-printed a low cost cargo box for this purpose. One of the most innovative feature of the system is its precision landing system which used sensors and a processing unit which solved the large errors in GPS locational and altitudinal accuracy (the accuracy was up to 5m horizontally and up to 20 m vertically). This allowed the drone to detect three sized markers on a landing mat from up to tens of meters of height above the ground, and safely land the drone over the marker without requiring any human intervention. 

A system has been built that is centered around drones-as-a-service for sputum sample collection which can be implemented to other medical services. This is surely a catalyst, as it shows the world how a common drone could be easily customized into a life saving drone for medical deliveries connecting patients and medical services of the local need.

Over a period, the drones directly served 1915 people with the transport of their sputum samples and diagnosed 62 people with TB. Moreover, dozens of Community Health workers and health care professionals in the district are being served with this project. 

The number will reach more than a double as we move ahead with the current operations and also connect other rural health posts in the location. 

The number that it will be serving in 5 years would be around a ten thousands in total. 

As eloquently stated by Margaret Chan, the world has committed to universal tuberculosis (TB) care. To achieve this requires combating TB in all its myriad settings. The WHO’s  End TB strategy has set a target of zero TB affected families facing catastrophic costs by 20 years within the framework of the wider goal to  reduce global TB incidence to less than 10 per million population by 2035. 

Around 70% of Nepalese are carriers of Mycobacterium tuberculosis and many of them are suffering from active tuberculosis disease. In fact, TB is the 4th leading cause of death in Nepal and countless rural cases of TB go undiagnosed because patients cannot access simple diagnostic tests and get free treatment provided by the government.

Nepal has made little progress against TB in the last decade. The first ever Nepal TB prevalence  survey conducted in 2018-2019 has shown that the true burden is 1.7 times higher than estimated by WHO in the past. This means that the scale of the challenge is much higher than previously thought. It is now clear that over 20,000TB cases are ‘missing’ in Nepal each year. Many of these cases occur in poor rural households unable to access a TB diagnosis. 

The National TB Program has set a target to diagnose an additional 20,000 cases of TB over the next 5 years to close this diagnostic gap, but systematically reaching those in remote areas is extremely resource intensive. We mainly focus on the number of rural cases that we help to reach this target. Also, we use Tuberculosis incidence per 1,000 population as our main indicator for the overall development.

Directly, 6 people work directly for medical cargo drone delivery as full-time staff while a dozen other work as a part of our public health partner (BNMT) as they are responsible for sputum collection.  

Nepal Flying Labs(NFL) is the first and the Nepalese chapter of the global flying labs network currently in 32+ countries across Asia, Latin America and beyond. NFL has all the required resources to quickly deploy drones for a range of local applications such as surveying and mapping, data collection and cargo transportation. NFL facilitates and strengthens the local robotics ecosystem through organizing local “Drones-as-a-Service” Business Incubation Programs, implementing projects addressing the humanitarian, development and health sectors, organizing and providing hands-on Drone hardware and software trainings for various drone platforms and Social Good use cases.  

BNMT is a Nepalese non-governmental organization dedicated towards the improved health and well-being of the Nepalese people since 1967. BNMT envisions a new Nepal where all Nepalese are aware of their basic rights and are able to live healthy and productive lives, in a safe environment without having to worry about food, income or security regardless of their gender, ethnicity, disability or HIV status. BNMT Nepal is governed by a board of Nepalese nationals with diverse experience in health, livelihoods, climate change, and social and community development. The four pillars of BNMT Nepal are Promoting Quality Health Care and Ensuring Health Rights, Building Resilience to Climate Change, Policy and Advocacy Support. Since its inception, BNMT has supported the National TB Centre, playing a vital role in establishing the National TB Programme(NTB). BNMT has extensive experience of implementing TB projects in Nepal in collaboration with the NTB to enhance government activities and pioneer novel approaches. 

In all we do, we seek to reflect the following values:

• Inclusion: Local communities, knowledge and leadership are essential for positive and sustainable social change.
• Diversity: Our work is stronger and smarter when informed by different perspectives.
• Solidarity: We don’t fight racism with racism, the best way to fight racism is solidarity.
• Autonomy: Local communities should make and be responsible for their own decisions in the pursuit of positive social change.
• Humanity: Technology must be driven by shared human values.
• Humility: Sustainable impact happens through continuous learning in the service of others.
• Sharing: Through open sharing and collaboration, we multiply outcomes.

The solve challenge is one of the best way to showcase our medical drone solution that has actually saved lives in that past years by diagnosing TB patients in rural Nepal. I am highly interested to apply to Solve as being selected will lead me to accessing all those personal and organizational development supports and mentorship with a chance for other grants and funding opportunities. Furthermore, being a culturally sensitive and curious person, I am very eager to network with diverse leaders from around the world among the cohort of selected teams.  

Economic evaluation of a humanitarian project is always confusing and hard specially when it involves saving lives. Being a humanitarian professional, I believe it is very important to learn the key elements on analyzing the overall cost per impact of the humanitarian project. Furthermore, as the project needs further funding to operate sustainably and scale up to other locations, it would be great to have financial support to be able to learn about the key mantra for successful pitch that can bring more opportunities to find grants and donors. 

I would love to partner with other tech organizations that are working in the field of frontier technology, humanitarian technology specially in the field of global health, humanitarian action, youth in STEM and disaster risk reduction management. Right partnership is always crucial and can become the main key towards success of the project.

Firstly, this project is the only project in the South-Asian region where drones have been successfully implemented not just as pilot-project but for actual transportation of hundreds of samples of old and vulnerable population for the diagnosis of Tuberculosis. 

Secondly, this is a unique project in terms of partnership as the Ministry of Health and Population itself is a leading partner while there are nonprofits and NGOs in the drone and health sector working together for the common goal of improving rural healthcare through the introduction of frontier technology. 

Furthermore, as the main theme of this award is towards facilitating the community health workers and service users at last mile in ensuring life-saving medicines and accessible health facilities, the project is a perfect example as it has been aiding the community health workers to transport sputum samples for rapid diagnosis and treatment of Tuberculosis. 

Moreover, drones being an available technology used by the whole world for cinematography and other recreational purposes have been modified and being used for humanitarian purposes. Therefore, this example of localization shows that a technology can be integrated with the health system to efficiently intervene the orthodox practices of transportation and diagnosis. 

At last, the same solution and/or network existing in Pyuthan district can be used to transport other medical samples as well as medical supplies including vaccines that are temperature sensitive (using a cold chain cargo box).