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When the Silicon Valley robotics company Zipline first dispatched a fleet of drones to Rwanda in 2016, it was hailed as a lifeline. The company’s delivery drones promised to slash the time it took to deliver blood supplies to hospitals. And it has. But as the stature of Zipline and other medical delivery drone services operating in Africa have grown, they haven’t just provided answers to African health challenges. They’ve also raised a slew of new questions – particularly about the value of high-tech solutions for what are often, at their core, low-tech problems. Investment in specialized solutions can help address one problem, experts say, but it does little to address the deeper challenge. For example, if you need to have drones deliver blood because of poor road networks, why not build roads instead? “This isn’t to say that governments like Rwanda’s shouldn’t invest in forward thinking technology and thinking...,” says Jennifer Foth, a technology and public health expert. “But what’s the potential trade-off if we’re so focused on these new leapfrogging technologies that we ignore more boring infrastructure that serves other needs as well?”
It’s 10:39 a.m. when the phone inside the Zipline pharmacy begins to buzz.
“Emergency order received from Kabgayi Hospital for four units of O positive platelets,” announces the pharmacy tech, and the room around him whirls into motion.
By 10:46, four small bags of liquid are carefully packed into an insulated cardboard box, and by 10:53 the whole contraption is loaded up and ready to depart for the hospital.
Then, just as the red numbers on the digital clock in the pharmacy flip to 10:56, the delivery drone hurtles up an inclined metal track outside the pharmacy windows, slingshotting itself over a landscape of leafy banana trees and tidy squares of farmland.
Today, 20 percent of Rwanda’s blood supply is delivered to hospitals this way, in tiny unmanned aircraft that launch from a distribution center in this small town an hour outside the country’s capital. The drones are the invention of a Silicon Valley robotics company called Zipline, which is contracted by the Rwandan government to parachute blood supplies to 21 of its public health centers.
Since the drones first took flight here in October 2016, they’ve earned a flurry of international attention and praise. But as the stature of Zipline and other medical delivery drone services operating in Africa have grown, they haven’t just provided answers to African health challenges. They’ve also raised a slew of new questions – particularly about the value of high-tech solutions for what are often, at their core, low-tech problems.
Drones, for instance, have often been touted for “leapfrogging” over problems like bad roads, isolated hospitals, and a lack of delivery vehicles in order to bring healthcare to the world’s poorest and most isolated people.
But some public health experts worry that by focusing on flashy technologies, governments and donors risk obscuring the deeper problems that made the fancy solutions necessary in the first place.
In Ghana, a similar deal between Zipline and the government recently sparked backlash from some members of parliament and leaders in the medical community. MPs called it a “high-tech vanity project” and the Ghana Medical Association has called on lawmakers to halt the deal, saying that it will not solve the nation’s most pressing healthcare problems.
Similar concerns have been raised in Rwanda. For example, if you need to have drones deliver blood because of poor road networks, why not build roads instead?
“Solutions like drones might feel very innovative, but they don’t replace the long-term needs for things like better infrastructure and better staffing,” says Donna Patterson, the director of Africana studies at Delaware State University and a public health expert. “They may temporarily reduce some health inequities, but what we really need is greater investment in the longer-term solutions.”
Better roads, for instance, wouldn’t just make it make it easier for supplies like blood to reach remote hospitals. They would also make it easier for people to get there as well – crucial in areas where travel time and cost are major factors in keeping patients away from healthcare. And good roads are a crucial part of development more generally. Without them, staple goods are more expensive, and both people and products have trouble getting to where they can be most useful within a country.
But fixing big-picture problems like bad road networks is a sprawling, expensive task whose payoff may be years or decades away. And that can make it a harder sell for donors and governments looking for the short-term payoff of a mission accomplished, Dr. Patterson says.
Determining the ‘true cost’
After drone #164 – or as the company calls it, a “Zip” – whizzes away from the Zipline distribution center in Muhanga, an iPad set up beside the launch pad shows it creeping along its preset flight path toward the hospital about three miles away. Package 19632 is on its way to Kabgayi, a text message tells the hospital staff. Estimated time of arrival is 11:03.
Five minutes later, the drone arrives, swooping low over the hospital as it drops the box from its small cargo hold. A paper parachute attached to the box billows open, and it lands softly near the hospital doors.
Drones sit at the intersection of two of the country’s biggest ambitions: to expand healthcare access and to cast itself as a technological leader in East Africa. The country’s health ministry has promised to put essential health services within 30 minutes of all of its citizens, and has expanded high-speed internet access so quickly that fiber-optic cables have arrived in parts of rural Rwanda more quickly than roads. When Zipline offered its services here, the government quickly shifted its aviation regulations to make the drones’ flights possible.
“It’s the greatest investment we have, our people, and every single opportunity that can add value to what we’re doing [for their healthcare], we take it,” explains Rwandan Minister of Health Diane Gashumba in a Zipline promotional video.
Neither Zipline nor the Rwandan government – which pays the company a monthly subscription fee – will say how much the drone deliveries are costing them, but the company's deal in Ghana is slated to cost $12 million over four years.
But Zipline’s director of national implementation for Rwanda, Israel Bimpe, says there are also many hidden costs in traditional deliveries – like time spent by rural healthcare workers traveling to collect supplies from depots or larger hospitals. And since trucks typically transport larger quantities of medical products, they’re more prone to waste if those products aren’t needed in the end.
“Drones don’t replace vehicles or healthcare workers, but they can complement them,” he says. “Those things need to be in place, but health supply chains are also messy, and drones can help with that.”
The company is getting ready to expand delivery to include vaccines and other medical supplies in Rwanda.
The value of those services, however, will depend on how they’re used, says Jennifer Foth, a technology and public health expert and author of the Quartz opinion piece, “We haven’t considered the true cost of drone delivery medical services in Africa.”
It’s one thing, she says, for a drone – nimble and fast – to deliver small quantities of blood, or emergency medicines like anti-venom or a rabies vaccine, to a hospital in an emergency. But when it comes to more routine deliveries, there’s less of a case for the high-tech option.
“This isn’t to say that governments like Rwanda’s shouldn’t invest in forward-thinking technology and thinking, or that they have to go through every stage of development that other countries went through to get to the same place,” she says. “But what’s the potential trade-off if we’re so focused on these new leapfrogging technologies that we ignore more boring infrastructure that serves other needs as well?”
At 11:10, the Zip announces its return to Muhanga with a high-pitched whine. It swoops toward the ground, its hooks snagging on a line designed to catch the drone and bring it back to earth. Two engineers in Zipline hoodies and skinny jeans stand up from their Macbooks and rush toward it.
By 11:13, they’ve removed the wings and battery, and the body of Zip #164 is hanging back on the wall, awaiting its next mission.