By Edwin Ambani Ameso and Gift Mwonzora
While medical drones can be lauded as game-changing health technologies that help save lives, and usher efficiency and cost-effectiveness in the often contextualized as fragile African health systems, Edwin Ambani Ameso and Gift Mwonzora argue that this is not the complete picture.
The sight of desolate buildings, makeshift health settings characterised by a shortage of drugs and machinery and demoralised workers is an enduring reality of African health care centres. Medical professionals staffing these under-resourced health institutions work under depressed morale. The deplorable state of the African hospitals and clinics continues to affect in large part the underprivileged and often impoverished citizens. To fill in the gap where governments are failing to implement the right to health, some non-state actors like the Melinda and Bill Gates foundation have perennially stepped up. Thanks to the presence of vertical medical programmes funded through the assistance of donor agencies like USAID, UKAID, GIZ, DANIDA, NORAD, CIDA and more, this has saved somewhat dire situations.
While such assistance has helped improve the healthcare contexts for citizens, most African states have been left with the solitary and unfashionable role of coordinating healthcare initiatives rather than providing health as a public good accessible to all its citizens. Critical to note, however, has been the endless political rhetoric by African elites seeking political office who entice the electorate with the hype of ‘Health for All’. Often such public pronouncements are not met with clear-cut plans for providing universal access to healthcare for largely underprivileged portions of global citizens resident in the continent.
(Images: A poorly furnished health facility and an open-market option for uncertified drugs in Ghana)
These governments anchor their political promises to the global health agenda of universal healthcare delivery with lofty promises of leaving no one behind. It is in such contexts characterised by fragility, shortages, stock-outs, postcolonial legacies of poor infrastructures, and more grounded structural concerns that we are witnessing a rapid uptake and use of digital health technologies, notably medical drones, to leapfrog the aforementioned challenges. Thus, questions arise whether the real and imagined futures of healthcare access in Africa can in the long durée afford and embrace medical drones as the future of healthcare delivery.
Medical Drones as the ‘Gamechanger’
The advent of Artificial Intelligence has transformed barely all sectors with the health sector being no exception. African countries like Malawi, Rwanda, and Ghana have resorted to the use of medical drones within their healthcare sectors. The use of these transformative new technologies to improve health patient profiling and facilitate the delivery of emergency medicines is indeed a welcome development in Africa’s healthcare system. Although commendable, however, such innovations don’t address the underlying structural, administrative, and governance issues afflicting Africa’s health care system.
It stands to reason that, whilst African political elites can embrace medical drones, they should at least capacitate their healthcare facilities with the supportive infrastructural facilities and resources essential to service delivery. From the constant stockouts to the shortage of health professionals and the critical lack of energy (including solar power) to serve these health facilities, African citizens’ right to health is compromised. For example, in the case of Ghana and Malawi, our research established that energy supply which is a critical component in health service delivery was often in limited supply. Yet, energy remains critical in preserving the potency and efficacy of vaccines and other cold chain medicines. This is a reality that could not be addressed by the mere use of drones. It is on this account that we contend that, without addressing the underlying challenges afflicting the sector, medical drone technology alone will not be the silver bullet to cure Africa’s crumbling health sectors.
A sober reflection of the introduction and use of these medical drones in such contexts must include the consideration of long-term investment in healthcare funding by the African governments. This shifts the burden from the multilateral agencies and development partners who have constantly accounted for and account for the large healthcare funding owing to the failure of national governments to step up to action. To think that the introduction and embrace of medical drones is the solution to Africa’s deplorable healthcare system will be a wrong diagnosis. They can neither substitute the conventional supply chain and logistics of healthcare drugs and sundry, nor can they address all the current challenges punctuating Africa’s remote rural clinics and hospitals. Rather, complementarity works best.
Medical Drones to Serve Whose Interest?
In the age of rapidly advancing medical technologies characterised by a steady but growing uptake and embrace of medical drones by African governments, questions have begun to emerge, asking to whose benefit and in whose interest the embrace and use of medical drones actually is. Countries like Ghana for example, have engaged in contractual agreements including a four-year engagement with a Zipline drone company to takeover 4 million dollars as part of service delivery. Whether the service provision from these medical drones is worth the large sums of investments is a subject of varying contention, especially in the light of the meagre health budgets of most African governments. Over the past decades, most African governments have allocated little budgetary support to the health sector, despite falling far short of the stipulations of the Abuja declaration which call for at least 15% budgetary allocation to the sector.
Again, in hushed tones, others have started to speak of job displacement, especially in the logistics (supply chain) industry. But this, however, seems farfetched. After all, not all medical deliveries will be done by drones. So, the fear of job loss and loss of contracts to the procurement and delivery companies will just be a misplaced fear – at least for now. Be that as it may, to the African populace that has witnessed time and again the poor governance of African health care including shady procurement systems, valid questions around the interests, use, efficacy, motives, impacts, and outcomes deriving from the adoption of medical drone technologies by African elites continue to be raised. We may see that in some cases, some governments may acquiesce to the relentless profit seeking pursuits by the drone companies as demonstrated in Ghana, Rwanda, and now Kenya.
Against this background, there is a need for robust research on whether African countries need these drones. If so, to serve which health areas and how successful have they been in saving lives in areas where they have been utilised so far? If found ineffective, what should be done, and with what urgency, to remedy the situation? Issues of the procurement and supply chain management of these drones at a government level also remain critical. This is considering African government elites’ proclivity to flout tendering processes: a trend reeking of grand corruption schemes.
These schemes have birthed what others have referred to as the ‘tenderpreneurs’ within the African healthcare systems. Worth noting have been the cases of looting of COVID-19 funds and the subsequent inflating and overpricing of medical accessories among various African countries. How then do we guard against state-led grand heists and corruption clothed under the procurement of moon-shot medical technologies with lofty promises of saving thousands if not millions of lives in much of Africa? We contend that to simply adopt such technology without also addressing the governance side in several states would simply be tinkering on the edges.
We maintain that even if African governments embrace the digitalisation of the health sector without a change of conduct all efforts will come to naught. Digitalising the health sector is ideal but seems to be favouring private players such as drone companies whose contractual engagements with African states guarantee their health funds cut. This then leaves the health care budgets skewed to the detriment of the whole health system where human resource deficits, stockouts, and ill-equipped health settings persist.
Africa’s New Era of Digital Health Technologies
To then celebrate the digitalisation of the health sector without the concomitant financial support of the sector will be an disingenuous act on the part of African ruling elites who are failing as duty bearers to guarantee the fundamental right to health for all citizens. This is sometimes in ways hard to see if one is to swallow the populist narratives of ‘health for all’ spewed during election campaigns.
Currently, the urge to embrace these technologies as essential to meeting the World Health Organisation’s triple billion target seems to be a politically driven promises of precision health delivery.
Drones or No Drones: Time for a Reality Check
Today, more than at any point, unlucky children and adults are dying from kwashiorkor, malaria, and snake bites in remote areas in rural Africa. What should be done? Is digitalising medical health including access to medical care and attention the panacea to cure this malady
Numerous benefits of medical drones range from the facilitation of emergency medical supply delivery, rapid response to disease outbreaks, improvement of maternal and child healthcare, provision of telemedicine, and facilitation of remote consultations. These drones have also proved useful in other contexts in mapping and the surveillance of disease-prone areas. Further, it is observed that medical drones can also be effectively used in humanitarian aid delivery, especially on impassable roads. Others have even stated that relying on road traffic can only go so fast and so far. Undoubtedly, these drones are convenient for providing emergency relief and aid, especially in low-lying areas such as Malawi, Mozambique, and Zimbabwe. These are contexts prone to recurrent floods and cyclones.
The Road Ahead
In the end, successful adoption twinned with sustainable use of these drones requires a multi-stakeholder buy-in. This will include the collaboration between governments, healthcare institutions, donors, drone service providers, the aviation industry, and local authorities. Further, the buy-in (reception and acceptance) by the community is also paramount. It needs to be rehashed that without addressing the structural and underlying factors affecting Africa’s health care system, relying on drones alone as the magic bullet to cure challenges affecting the sector will be missing the forest for the trees. Medical technology needs to be anchored in a socio-economic, cultural, financial and political context which is not only permissible for innovation to thrive. The political will to stem corrupt practices, bad governance and other bulwarks that may militate against the full adoption and use of medical technology should be available. Absent due diligence, embracing medical drones in Africa without addressing the underlying structural, institutional, political, and governance factors will be akin to lofty ambitions of flying a kite where there is no wind.
Edwin Ambani Ameso is a postdoctoral Researcher at Universität Leipzig, Germany. He researches on “off-the-grid”: Infrastructures, processes of spatialization, and drones in Africa. His areas of research include health insurance, social protection and welfare, digital health technologies, infrastructures of care.
Gift Mwonzora is a Research Fellow in the Willy Brandt School of Public Policy at the University of Erfurt, Germany. He researches on digitalisation, politics and the future of work in Middle-Income Countries. His areas of Research include development policy, digitalisation, governance, democracy, human rights, social justice.
Note: This article gives the views of the authors, not the position of the EADI Debating Development Blog or the European Association of Development Research and Training Institutes.