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Drones to facilitate medicine delivery in remote areas of Madagascar
- Completed project
In Madagascar, the NGO Population Services International (PSI) has trialed using drones to deliver health products to fifty health institutions in remote areas of the country. FID has funded this project, which aimed to assess the feasibility, cost-effectiveness ratio and the impact implementing it would have on communities' health.
Project ported by:
Context
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.
Innovation
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.
Provisional results of the project and key takeaways
[March 2026]
On an operational level
- In 18 months, more than 1,570 flights carried 11,475 liters and 2,371 kg of health products (vaccines, antimalarial medicines, contraceptives, health products for mother and child) towards 55 health institutions in 6 districts. Vaccines reached the most isolated institutions in less than an hour compared to several days previously, meaning vaccination campaigns effects could be maximized. In 12 months, 60% of distributed vaccines were delivered by drone.
- The Ministry of Public Health played an active part in the design and strategic planning as well as assessing the results, showing strong interest in the project. The ministry named liaisons (supply chain regional committees) at central, regional and district level to make coordination and monitoring easier. A national working group dedicated to drones selected sites to ensure deployment aligned with the project's health priorities, regulatory conformity and long-term viability.
- To strengthen confidence in health services, training and targeted communication activities got the local community and health agents involved, including district pharmacies.
Key results: The drones had the expected impact in certain conditions
The drones significantly improved malaria diagnosis and treatment in rural areas (+14% of the diagnosis rate). On the other hand, no major effect was seen on access to modern contraception in general, and to other vaccines and health products (STI/HIV, tuberculosis), due these products experiencing problems upstream in the supply chain.
The study highlighted a major limitation of drone delivery likely to attract attention: drones cannot compensate for structural failings in the supply chain. They may be effective in reinforcing last mile distribution, but they cannot overcome bottlenecks upstream, at national level, like product rationing or the limited availability of central stocks.
More specifically:
- Institutions delivered by drone experienced fewer stock shortages of quick malaria diagnosis tests (a 10% improvement in stock availability was observed in the 55 health centers). The malaria diagnosis rate also rose by 14% in feverish children in the group benefiting from drone delivery.
- Women in the treatment group used their preferred contraceptives slightly more (an increase of 9% alignment between preference and use). In addition, no measurable difference was seen in current modern contraceptives use or stock shortages of other products not related to malaria. The researchers observed that for various reasons products were already absent or only minimally available in central stocks and therefore difficult to deliver by drone.
- The drones were especially useful in reducing stock shortages of product already in the national supply system, as had been the case for malaria tests. On the other hand, in the event of systemic shortage or interruption in supply (as had been the case for contraceptives), drones cannot fill in the gap.
From a cost-effectiveness point of view, projections suggest that delivering medical supplies by drone is cost effective both in the short term (1 year) and long term (10 years), in improving diagnosis and malaria treatment in isolated regions in Madagascar.
Nevertheless, results are highly affected by operational costs and system utilization levels. With low use (60 flights per month for example and by take-off base), fixed costs are distributed over a limited volume of deliveries, which means higher unit cost. As the number of flights increases (100 flights per month for example), these costs are spread over a larger quantity, significantly improving cost-effectiveness.
Key takeaways and outlooks: two priorities emerge
At this stage, the corresponding key takeaways and outlooks are: With a view to scaling up, an important conclusion to be made is that drone programs can supplement efforts to reinforce national supply chains.
The main challenge in scaling up drone deliveries of medical supplies for political decision-makers lies in maintaining operational efficiency as complexity, geographical scope and the number of deliveries increases.
The project team intends to continue its work focusing on two priorities:
- closely analyzing cost indicators (cost per flight, population reached, lives saved);
- maximizing national return on investment and cost-effectiveness by creating a network of interconnected drone bases.
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
Projects
Projects funded by FID
