MedicalConnect: Drones to Supply Africa

The consistent and reliable supply of medical products to remote, difficult-to-reach health centers and patients in Uganda has been a long-standing challenge. Some of the issues identified include:

• Product shortages and stock-outs including blood, drugs, and reagents;
• Slow turnaround time (TAT) from collection of samples to results delivery;
• Limited, costly, & delayed handling of individual and emergency requests;
• Surface transport challenges due to road and weather condition
• Difficulty in supporting village-based health teams.

We propose an innovative supply-chain solution using specially designed medical drones, (unmanned aerial vehicles UAV) for on-demand delivery of essential medicines, diagnostic tests, medical supplies, and personal protective equipment (PPE), featuring community management and ownership.  

This approach improves performance; reduces handling and risk of infection; reduces time of delivery, and is ready for immediate application.  The use of Drones is scalable once proof-of-concept has been established, and promises to transform the quality of life in rural Africa.

We aim to serve Africa's last mile villages and regions with an on-demand supply chain that is community owned and operated.  An example of a community we plan to serve is Kalangala District, an archipeligo of islands in Lake Victoria. Kalangala illustrates the challenges we intend to overcome.  The 66,000 residents of Kalangala who live on 43 inhabited Ssese Islands in Lake Victora are separated 76 kilometers from the mainland, and completely dependent on ferrys for the transport of goods and people.  From the main island of Kalangala, one takes smaller motorboats to reach the outer islands.  In a medical emergency, a patient can be treated on the island if medical supplies are on hand, or return to the mainland, on one of two daily ferries.  This can take up to 6 hours, and the ferries operate only during daylight.  A medical emergency at night must wait until the following morning. Blood transfusions are a particular challenge.  The earliest a ferry can deliver plasma is 4-6 hours, while a drone dispatched from a blood bank on the mainland can reach Kalangala in 30 minutes.  ARVs and other medicines also need to be delivered to the islands on an urgent basis.

We propose to implement a state-of-the-art drone delivery system (logistics hub) in Kalangala District in the Ssese Islands of Lake Victoria, that specifically addresses public health service delivery.

Kalalanga District has unique health-service challenges including dependence on water-based public transport -- the main lifeline for the District. Recently  rising water levels in Lake Victoria caused temporary cessation of ferry services, effectively cutting the islands off from the mainland.

The proof of concept is proposed for Kalangala District because:

• Remote community, hard to reach health centers, and villages'
• All movement of goods & people between islands is boat dependent;
• Boat-based transport is subject to weather, passenger load, and does not operate night due to the many underwater hazards;
• Kalangala is close to the lake border with Tanzania and receives traffic
  from Tanzania, hence potentially adding to COVID-19 risk

MedicalConnect proposes a project that operates in partnership with District Government, and one which community decision-making and day-to-day control of the Drone operation is managed by the joint District and MedicalConnect teams.  This partnership features participatory decision making; community ownership; transparent operations; computer-based tracking of operations; accurate accountability; and earnings returned to the community.

The need and demand for drone services in Kalangala have been identified by informal research and consultation with health officials in the district.  This project will serve all 66,000 residents living on the 43 inhabited Ssese Islands of Kalangala District which sits 76 kilometres from Entebbe on the mainland. Islanders are subsistence farmers, fishermen, traders, and civil servants.  

We have engaged community leaders, local officials, hospital staff, the red cross, and NGOs in assessing the need for drone services. There is keen interest and support for this proposed service. Doctors at the main hospital in the district were emphatic that the need for timely delivery of blood products and medicines would be invaluable in saving lives, and in their plan to upgrade the HC-IV level island hospital to a District Hospital. It is the expectation of District officials, the blood bank, and other proposed partners that drone services in Kalangala have the potential to provide a much more timely, flexible, accountable and cost-efficient service than relying on public transport, boats and conventional means.

Before COVID-19, Uganda was preparing for a possible Ebola outbreak that had broken out last year in Eastern Congo on the Ugandan border. This project has the potential of being utilized for both COVID-19 and Ebola pandemics, as well as to strengthen public health logistics systems to serve remote communities with the consistent delivery of essential medicines and supplies. The nature of unmanned drones limits handling and viral exposure.  This project is responsive to the COVID-19 pandemic; supports and strengthens existing health supply chain systems; and serves as pandemic preparedness for future Ebola or other disease outbreaks in the future.

We have looked closely at drone applications in other settings, and developed our system differently.

Key key differences that make our concept both different and innovative are:

• Community-owned, community managed, independent operations;
• Using drones that suit the task / multi-drone management;
• Multiple applications and uses on a single platform;
• Sustainable business model with revenue sharing;
• Locally-developed, user-based support systems;
• Ability to integrate third-party systems;
• Training and empowerment to enable local maintenance and repairs;
• Contributing to community-based programs, eg: education, development;
• Collaborative R&D based.

The drone hardware and core operating systems have been developed and proven, and will evolve further with experience.  We start with needs not hardware, letting the community participate in decision making. Starting with modest hardware, we expect the second phase of operations to include drones more suitable for use in village settings to avoid landings and handling to as we expand to serve even more remote areas.

Key differences of our concept are:

• Community-owned, independent.
• Use any drone / multi-drone management.
• Multiple applications and use cases.
• Sustainable business model with revenue share.
• Locally-developed support systems.
• Ability to integrate third-party systems.
• Local maintenance and repairs.
• Contributing to community programs, eg schools.
• Collaborative R&D based.

We are developing and applying new software based technology but also, new operational and management models. Our approach is focused on the people and management side - using soft technology - and to rapidly become both affordable and sustainable. To go beyond a transport system only, and embed the service as a community asset.

Drone technology used in serving the medical supply chain is but one of the innovations we expect to bring to bear in this solution.  Our principle aim is to transform the way communities identify, and address their own needs, and to enable a demand-driven supply chain. The lead-in app we expect to use was developed by the BloodConnect project, technology from which will be deployed in the MedicalConnect order and fulfilment application.  https://play.google.com/store/apps/details?id=com.bloodup.hospital.app

We plan to commence drone operations where there are service gaps / challenges due to remote location, difficult road access, and a history of insufficient services. In the process of solving those challenges, it is our belief that community-based and operated drone operations and the range of services it can offer will become more mainstream and adopted widely wherever supply shortages occur.  Drones can and will replace other existing modes of supply once they are proven viable. For instance, drones can be a value addition to the National Samples and Results Network NSRN) which sends and receives diagnostic test results nationwide to diagnose illness, and to detect epidemics and outbreaks. This diagnostic data needs to collect data in real time, and drones can assist in providing both the the first and last legs of this national testing services.

Two of the technology-based companies that FlexDrone will work with have tested and demonstrated the products we plan to utilize in the project.  RigiTech is a high-quality drone manufacturer, and EVA produces state-of-the art drone stations. Links to their products is provided here:

http://www.eva.xyz/

https://www.rigi.tech/

We believe the key to success for this solution is to affect change in the thinking at the national, district, and local government levels from operating a national, supply-based "push" delivery system to a locally-controlled, client-oriented, demand "pull" supply system. The goal is to enable a supply system that is much more responsive and agile than it is currently configured. In this way, we expect to be able to assist government to optimize the whole supply chain. 

In essence, our approach is to establish the use of drones as the leading edge of a total demand-driven supply solution, that is needs based, client oriented, cost-effective and locally developed and managed, unlike other projects using drones that focus on providing fixed hardware at high cost as a contracted service.

Initially, we propose to demonstrate our prototype model drone service in the remote, and relatively lightly-populated Kalangala District, of the Ssese Island in Lake Victoria, situated 76 kilometers off Entebbe on the Ugandan mainland.  In Kalalanga we will serve 67,000 population living on 43 inhabited islands, with an anticipated direct benefit to 30%, or 22,300 persons.

In year 1: We plan to continue serving Kalangala, and expand to a remote district on the mainland in Eastern or Northwestern Uganda north of the Nile River, and by the end of year 1, expect to be serving a population of 500,000, with direct benefits to 167,000.

By year five, our goal is to be providing two way, and on-demand drone services in 3-4 Districts, serving a population of 3-5 million, and providing direct benefit to between 1 million and 1.5 million people.

Our primary goals within one year is to:

1.  Demonstrate the efficacy, and cost effectiveness of our model in a proof-of-concept trial in Kalangala District, on Lake Victoria;
2. Secure the approval of both local and national authorities to scale the drone operations to other remote regions of Uganda;
3. Expand drone services to at least one mainland district, serving a population of 500,000, further demonstrating the value of the model in a more heavily populated region;
4. Continue deliberate expansion over years 2-5 to achieve, by year five, on-demand drone operations in 3-4 Ugandan Districts, and to large refugee populations, serving a population of 3-5 million.
5. In addition to drone operations in Uganda, we plan to expand to remote regions of Kenya as early as year two, pending availability of resources.

We have identified the following challenges or barriers that have to be overcome in order for this project to achieve its potential.  These include:

Challenges overall:

1. Establish health and blood bank worker ability/skills to handle drones;
2. Ally any public and cargo safety concerns regarding drones;
3. Establish community acceptance;
4. Achieve effective integration with existing health systems; and
5. Establish local commutation networks regarding drones use.

Specific challenges, first phase:  Year 1:

1. Securing the approval to import, test, and use drones for medical purposes;
2. Obtaining certification to operate throughout Uganda following a successfully Proof-of-Concept trial.

Second Phase: Year 2-5:

1. Complete sufficient demonstrations, and gather the trial data necessary to satisfy partners that this solution delivers what it promised, paving the way to scale medical drone operations to serve additional Districts and populations.
2. Establish and document the set up, work systems, training, test flight protocols, and other best practice elements of our system in order to scale the methodology and operations to 3-4 larger districts in Uganda, and to one district in Kenya by year five.

We have confidence in our model, and technology, and plan to demonstrate efficacy, cost-effectiveness, safety, compatibility with existing health systems; and the practical application of drones in medical supply. In both the initial trial in the Ssese Islands of Lake Victoria, and in subsequent expansion sites, we will carefully document deliveries accomplished, lessons learned, community acceptance, and systems integration, along with a number of other quantifiable metrics. In reference to identified barriers, we expect to overcome each with demonstration, and actual hands-on experience.  Unlike many other health services, drone services are highly visible, and serve as a constant reminder that services and essential supplies are available, even in most remote regions of the country..

We expect to have a team of approximately, 18-20 persons in total, of these, 10 will be full time, and 10 part time: 

1. Project/business manager;
2. Operations / site coordinator; 
3. Drone operations Manager/ Logistics
4. Assistant Drone Operations:
5. Drone technician / repairs;
6. Software manager; 
7. Two technical support/software developers
8. Commercial/partnerships manager' 
9. Finance manager;
10. Finance assistant
11. Community engagement specialist
12. Systems trainer and educator;
13. Data analyst / M&E specialist;
14. Robotics and coding skills trainer; 
15. Medical / health systems advisor;
16. Two (interns)

Contractors we expect to hire as needed, include:

• Software developers;
• Health information system experts;
• Logistics/Supply chain consultants;
• Electro-mechanical engineers;
• Communications personnel;
• Security personnel

Our team and planned additions is comprised primarily of Ugandan nationals with experience in the following disciplines:

• Management, partner & donor engagement;
• business & economics, including economic modeling;
• drone operations including mapping and modelling;
• logistics, health supply chain systems; 
• medical practitioners, including doctors and nurses;
• robotics, biomedical engineering, specialised manufacturing.
• medical software and communications, and;
• community development 

In addition to direct hires, we will be working closely with local and international partners who bring complementary expertise to our solution.

The Flexdrone team has worked at ground level over two (2) years to understand the situation, needs and wants of the public, health workers, administrators, service providers and funders, and design a solution from the ground up to best fit local needs and build local capacity, unlike all other medical drone solutions, which have been designed from the outside-in.  The stakeholders in our project are not Governments or big donors but community members of different kinds and the people who directly service them, working on the frontline of community health and development.  This includes under-stress doctors and un-empowered village-based health workers, mothers about to give birth that need blood to be available and people with HIV who cannot afford to travel to health centers for treatment.  It is this local understanding, intimacy and trust that underpins our approach and ability to achieve results.

MedicalConnect will be working primarily with public health authorities including infectious diseases, hospital services, laboratory services and blood banks. We will also work with NGOs running health programs and private health care providers working at the last mile. Out intention is to supplement the existing supply chain, and using drone and app-based technology to overcome issues with conventional road and boat transport. 

Planned partnerships with the US AID funded RHITES programs involve TB sample collection at village level; with Uganda Cares - HiV commodities, CDC-funded Rakai Health Sciences Program - TB and HIV viral load samples collection and results delivery; Malaria Consortium - distribution of malaria products; Health Access Connect - delivery of reproductive and sexual health products; Public Health (hospitals), for core & emergency commodities including blood from mainland blood banks; and with Living Goods - providers of early childhood care products via a community health promoter model.

Our business model is based on delivering on-demand transport-based drone services in partnership with public and private sector organisations and individuals involved in provision of health services in rural, remote areas of Uganda that are community operated and financially self-sustaining. Results in the form of drone trips taken, and supplies delivered will be measurable, and transparent.  We expect that overtime the cost of drone-based services will lower than current land and boat transport of goods and supplies, and measurably more effective.

Initially we are seeking a grant to further develop our solution, demonstrate it, and move towards commencement of routine operations. We expect to transition immediately following the proof-of-concept demonstration into pay-as-you-go services utilizing existing funding streams that are used in inefficient, land-based supply chains. It is our expectation that 100% of the cost of operations can be recovered, working across several funded use cases in addition to on-demand medical supply, eg. drone based agricultural mapping, aerial photography, and other community-based applications for drones.  No donations or grants are expected to be required moving forward, except perhaps for capital developments, though we intend to also seek out debt financing if necessary.  This is possible because of the low-cost, flexible model we have adopted. We have engaged in discussions with drone manufacturers to lease hardware, so that we get the right drone for the operation, unlike other drone programs that start with expensive hardware, and try to fit the solution to the technology.  We intend to let community needs drive decision making, and fit the technology to the solution.

We are approaching Solve because the use of drones in Africa is so new that government and bi-lateral donors do not yet understand how this technology will fit into existing systems, and are reluctant to try an untested approach.  MIT Solve gets technology, and its applications, and in addition to outright funding, offers to link innovators into a network of tech-savy individuals and organizations that can help us bring this new approach into the proof-of-concept trials that are needed to convince decision makers that drone services need not be expensive, and high-risk.  We have seen that government officials are risk-adverse, and understandably reluctant to try something new and untested.

We could use help in refining our business model, and understanding how to evaluate it better.  Particularly in the area of cost effectiveness, as we are talking about replacing only a portion of an existing supply chain.  In this regard, the advice of a health economist would be most helpful.

On our solutions technology, we need to better understand how to integrate the several technologies that we intend to utilize -- drone delivery; app-based ordering; performance tracking software; cargo handling...

We would also benefit from advice on funding and financing options.

Being somewhat isolated in East Africa, we lack the technical and financial connections that could help us refine and demonstrate our innovation. We understand that Solve offers access to a range of expertise, researchers, commercial-development and connections, and also, has can advise on how we might seek further funding for our innovation at a level that suits our potential and stage of development. 

We were attracted to the stated purpose of the Elevate Prize for Health Security and Pandemics because our innovation addresses both the urgent task of COVID-19 pandemic response, it also creates a model for pandemic preparedness for Ebola and other potential outbreaks in the future.  More importantly, our innovation addresses health security directly as we seek to supply the most health in-secure, and remote regions of Africa.

We also admire the stated focus of the Elevate prize "to dramatically amplify the impact of innovators, activists and problem-solvers" as we think of ourselves as having all of those attributes.  However, do not see ourselves as heros, rather we intend to awaken the heroes that live in the neglected villages and remote regions of Africa who will no longer be neglected.