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Bi-directional drones to strengthen healthcare provision: experiences and lessons from Madagascar, Malawi and Senegal
  1. Astrid M Knoblauch1,2,3,
  2. Sara de la Rosa4,
  3. Judith Sherman5,
  4. Carla Blauvelt6,
  5. Charles Matemba6,
  6. Luciana Maxim6,
  7. Olivier D Defawe7,
  8. Abdoulaye Gueye8,
  9. Joanie Robertson9,
  10. Jesse McKinney3,
  11. Joe Brew3,
  12. Enrique Paz10,
  13. Peter M Small3,
  14. Marcel Tanner2,
  15. Niaina Rakotosamimanana1,
  16. Simon Grandjean Lapierre1,3,11
  1. 1Mycobacteria Unit, Institut Pasteur de Madagascar, Antananarivo, Madagascar
  2. 2Swiss Tropical and Public Health Institute, Basel, Switzerland
  3. 3Global Health Institute, Stony Brook University, Stony Brook, New York, USA
  4. 4UNICEF Supply Division, Supply Chain Strengthening Centre, Interagency Supply Chain Group, Copenhagen, Denmark
  5. 5UNICEF Malawi, Lilongwe, Malawi
  6. 6VillageReach Malawi, Lilongwe, Malawi
  7. 7VillageReach Seattle, Seattle, Washington, USA
  8. 8PATH Senegal, Dakar, Senegal
  9. 9PATH, Seattle, Washington, USA
  10. 10UNICEF Madagascar, Antananarvio, Madagascar
  11. 11Centre de Recherche du Centre Hospitalier de l’Université de Montréal, Montréal, Quebec, Canada
  1. Correspondence to Dr Astrid M Knoblauch; astrid.knoblauch{at}


Drones are increasingly being used globally for the support of healthcare programmes. Madagascar, Malawi and Senegal are among a group of early adopters piloting the use of bi-directional transport drones for health systems in sub-Saharan Africa. This article presents the experiences as well as the strengths, weaknesses, opportunities and threats (SWOT analysis) of these country projects. Methods for addressing regulatory, feasibility, acceptability, and monitoring and evaluation issues are presented to guide future implementations. Main recommendations for governments, implementers, drone providers and funders include (1) developing more reliable technologies, (2) thorough vetting of drone providers’ capabilities during the selection process, (3) using and strengthening local capacity, (4) building in-country markets and businesses to maintain drone operations locally, (5) coordinating efforts among all stakeholders under government leadership, (6) implementing and identifying funding for long-term projects beyond pilots, and (7) evaluating impacts via standardised indicators. Sharing experiences and evidence from ongoing projects is needed to advance the use of drones for healthcare.

  • drones
  • madagascar
  • malawi
  • senegal
  • supply chain
  • universal health coverage
  • unmanned aerial vehicles (uav)
  • unmanned aircraft system (uas)
  • remotely piloted aircraft (rpa)

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  • Handling editor Seye Abimbola

  • Contributors AMK, SGL and SdlR conceptualised the manuscript. AK wrote the first draft of the manuscript. SdlR, JS, CB, CM, LM, ODD, AG, JR, JM, JB, NR, PS and SGL all contributed to the manuscript content. All authors provided iterative feedback on the manuscript and approved its final version. AMK and SGL are guarantors of the final manuscript.

  • Funding The DrOTS project in Madagascar was funded by the Stop TB Partnership’s TB REACH initiative supported by Global Affairs Canada. Unicef’s activities in Malawi were supported by UNICEF core resources. The VillageReach blood and oxytocin study was funded by Grand Challenges Canada and Silicon Valley Community Foundation. PATH’s work in Senegal was funded by a grant from the Bill & Melinda Gates Foundation. AMK is supported by the Rudolf Geigy Foundation, Swiss Tropical and Public Health Institute, Basel, Switzerland. SGL is supported by the Canadian Association for Microbiology and Infectious Diseases.

  • Disclaimer The views expressed herein are solely those of the authors and do not necessarily reflect the views of the organisations/agencies they work for.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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