Primary Care from the Sky : The Next Frontier
India has a vast public health infrastructure with 5335 community health centers (CHCs), 23,391 primary health centers (PHCs), and 145,894 subcenters. These centers provide health services to over 70% of the country’s population living in rural areas. These numbers look impressive. However, issues relating to physical infrastructure, manpower, equipment, drugs, and other logistical supplies need to be addressed for improving the quality of services.
There are around 1,355 PHCs without an all-weather motorable approach road.In several states, where the terrain is hilly orthe population is dispersed, people sometimes need to travel 10-20 km to reach the nearest PHC. There is also a shortfall of specialists, doctors (~6%), health assistants (~50%), lab technicians (~33%), and pharmacists (~ 23%) at PHCs. Absenteeism is high, and many of the doctors do not have the required expertise to fulfill their role at the health centers. Shortage of lab supplies, faulty lab and refrigeration equipment, and intermittent power supply add to these challenges.
The use of drones in healthcare delivery is not new. For example, in Rwanda, Zipline has beendelivering blood and medicines to remote locations within hours. When the drones reach the community hospitals, they drop small packages from very low altitudesusing simple paper parachutes and return to the home base. Zipline has flown more than 300,000 km in Rwanda delivering 7000 units of blood in over 4000 flights, with minimal wastage.Drones are also helping transport COVID-19 test samples in remote locations across several countries in Africa. Chile has launched a pilot drone program to deliver medicines to people living in remote rural areas.
Judicious use of drone technology can help address some of the healthcare access challenges in rural India.These are some of the areas that drones can make a significant impact.
Reducing Maternal and Infant mortality
In 2020, over four million children in India were born through institutional deliveries, and a little over 2,77,000 were home births. Around 1,24,000 thousand of these neonates and ~5000 mothers died during or post-childbirth. The major cause for this was infections due to birthing conditions and lack of access to clean supplies. These women and babies can be saved by providing sterilized birth kits that contain simple items like a sterilized razor blade, a string to tie off the umbilical cord, etc.Drones can help in the delivery of these birth kits, and other items required during childbirth,like hepatitis B vaccine, vitamin K injections to prevent excessive bleeding, erythromycin eye ointment to prevent infections and blood. This can be delivered to the respective sub-center or PHC for use by the midwife during childbirth.
Reduction in Turnaround time and Cost of Laboratory tests
Basic microscopy-based tests for tuberculosis or malaria normally take only a few minutes, but the delay in results in rural India can be as high as few days due to an issue in accessing laboratory facilities. Setting up in-house lab testing facilities at PHCs will help in reducing the turnaround time. However, this is an expensive proposition and is not sustainable due to a shortage of lab technicians in rural India. Some tests are time and temperature-sensitive and may need to be done within a few hours of the sample collection.Using drones on demand to transport blood and urine samples to the nearest laboratory will reduce the turnaround time, prevent contamination, and will also help extend all the services provided by the lab to the PHCs. This would also help in reducing the overall cost through economies of scale.
Access to medicines
Many PHCs are not connected with any form of public transport. Even if, public transport is available, this is limited to one or two trips per day. On average people need to walk 6-7 Km to reach the nearest health center to procure medicines. Additionally, there are issues concerning availability, pilferage, inventory management, and also the process of indent and supply of medicines at the health centers.
Using drones to deliver medicines on demand can help transform the supply chain, reduce the cost of inventory, reduce pilferage and help tackle the issue of spurious drugs. This will ensure that individuals receive their indented medicines on time.
Drones fitted with HD cameras and a high-speed data communication link can help extend telehealth facilities to post-operative patients even in the remotest parts of the country. For this to be effective it will need to be supported by a local health worker at the patient side. Combining this service with the delivery of medicines directly to the patient can help prevent complications,improve quality and reduce the cost of care.
Managing the spread of diseases and vaccination
The current COVID pandemic has been a learning on how to manage infectious diseases. The storage, indent, and supply of vaccines ensuring minimal wastage have been challenging. Drones can play a key role in delivering test samples and vaccines even to the remotest part of India, maintaining the cold chain. Drones are already being used for spraying pesticides to prevent the outbreak of diseases like malaria etc.
Reducing Deaths from Snakebites
Deaths due to snake bites are high in India. Around 58,000 people die every year due to snake bites and over 400,000 are left with permanent damage to their health. Most of the victims live in rural, forested, or agricultural areas. Many victims seek treatment from non-medical sources or do not have access to health care. For best results, antivenom should be given as soon as possible, but within four hours of the snake bite. The government programs to increase awareness need to be augmented with just-in-time delivery of antivenom using drones to the location of the snake bite. This will help improve the access, speed, and quality of care to snakebite victims.
Airborne leaflets are a powerful tool to change behavior. This has been used successfully for military propaganda since the 19th century. Using drones to drop health awareness leaflets in the local language can help augment the existing health awareness programs.
What was once thought of as science fiction a few years ago is now rapidly becoming a reality.In February 2019, the “Ministry of Civil Aviation”issued the “Drone Ecosystem Policy Roadmap”. This proposes the carriage of new forms of airfreight, recognition of services providers for airspace deconfliction and permission, and the ability to fly drones “Beyond Visual Line of Sight”.
Currently, there are a few trials underway in Telangana and Pune for the use of drones in healthcare. However, many more pilots need to be kicked off with a sense of urgency, as the impact could be huge on the Indian healthcare system. The number, location of the drones, and flight paths would need to be carefully designed to ensure the efficiency of operations. In this regard, there is a lot that can be learned from the ambulance service providers.
Drones present a tremendous opportunity to overcome supply chain and healthcare access challenges in delivering quality care to people living in rural India. While direct-to-patient solutions using drones may take some time, direct-to-clinic, or direct-to-health care professional-based solutions, will be increasingly adopted in healthcare.
To maximize the benefit,drone deployments must not be point solutions but should be integrated into the overall clinical or operational workflows.
(Srinivas Prasad is Founder and CEO of Neusights and the views expressed in this article are his own)