Drones to facilitate medicine delivery in remote areas of Madagascar

Up to a third of public health centers in Madagascar remain cut off from the road network for all or most of the year. This results in 20% of the community not having access to essential health care due to inadequate infrastructures and extreme weather conditions (cyclones, floods, torrential rain). Access to health care remains extremely difficult for about 19 million people living in rural areas, due to inefficient last-mile delivery systems. The direct effect is that the further away the central districts where supplies and health care are concentrated are, the more essential medicines shortages increase. Rural regions are subject to 7% more infant vaccine shortages than urban regions. Isolated health centers can remain inaccessible for 3 to 12 months a year and have to deal with stock not being available on a regular basis. Women who need to look after their maternal and reproductive health as well as children under 5 are the first to be affected by this issue.

It is essential to find solutions to get past the last mile obstacle to provide reliable access to medicines and vaccines, prevent avoidable deaths and improve the health of the most vulnerable.

PSI (Population Services International) has started using an innovative solution in Madagascar to supply fifty isolated health centers: drones supplement road transportation meaning last mile deliveries are uninterrupted throughout the year. The project has been launched near Mahanoro, the main town on the east coast of Madagascar.

By connecting district pharmacies to the most isolated health centers, the project looks to extend access to health care to the most vulnerable communities, by providing emergency stock of essential health care products. Amid expansion of drone delivery initiatives and how popular they are, PSI chose to do a randomized control test (the first in this area) to assess the impact of this service on community health, encouraged by promising results from an initial pilot.

FID funding has made this new approach possible: the actual impact of drone delivery on health systems is rigorously and independently assessed, and public decision-makers are given reliable data on the impact it might have, but also the challenges an approach like this faces.

The research team from the University of North Carolina, Innovations for Poverty Action (IPA), and PSI designed an impact assessment focused on two parts:

Several indicators in the first part measure the direct impact on the communities served:

• Reduction of unavailable stock of essential products (vaccines, diagnoses and antimalarial treatments).
• Changes in contraception practices (improvement in use).
• Improvement in vaccination coverage and malaria treatment.
• Perception of the quality of services.

The second part analyses the cost-effectiveness of delivering medical supplies by drone in the regions concerned, by concentrating on malaria diagnosis and treatment, access to contraceptives and delivery efficiency.

The study targeted 109 isolated health institutions, spread across 3 regions in east Madagascar (Alaotra Mangoro, Atsinanana and Vatovavy Fitovinany), with 55 served by drones, and 54 that were not, which served as the control group. Surveys of more than 3,000 women of reproductive age supplemented these data.

Research team

• Katherine Tumlinson is an Associate Professor in the Department of Health Policy and Management at UNC Gillings School of Global Public Health. She was the Principal Investigator for the randomised control trial.
• Emilia Goland is a doctoral student in Maternal and Child Health at UNC Gillings School of Global Public Health, focusing on global reproductive health and rights.
• Tara Templin is an Assistant Professor of Health Policy and Management at UNC Gillings, researching health economics of noncommunicable diseases in low-resource settings.

Ressources

• Tanaka A, Thomas E, Purves A, et al; Drones in healthcare, are they ready to fly? In BMJ Innovations Published Online First: 06 February 2026. doi: 10.1136/bmjinnov-2025-001420
• An article on the results of the impact assessment is due to be published in the journal BMJ Innovations