Report

Malawi drones for health randomised control trial: Baseline report

Valentina Brailovskaya , Mico Rudasingwa , Alison Connor , Tafwirapo Chihana , Innocent Mainjeni , Luciana Maxim 22 December 2023

Executive Summary

Problem statement:

Transportation challenges in remote and hard-to-reach areas hinder the provision of quality healthcare by impeding the delivery of essential medical supplies. To address these challenges, the integration of drone transport has emerged as a promising solution, particularly in countries like Malawi, where traditional ground transportation is unreliable due to long distances and difficult road access. Swoop Aero, a drone service provider, has partnered with the Malawi Ministry of Health (MoH) and the Department of Civil Aviation, with support from VillageReach, and funding from USAID’s Development Innovation Ventures (DIV) to expand the drone network and integrate drones into the national health supply chain system.

To assess the impact of drone services on the supply chain and proxy health outcomes, IDinsight has partnered with VillageReach and the Malawi MoH to conduct a two-arm randomised controlled trial (RCT).

Purpose of the document:

The purpose of the document is to present the findings of the baseline survey, offering insights into the existing condition of the supply chain in hard-to-reach facilities in Malawi.

Evaluation Design:

The evaluation includes 209 rural, hard-to-reach health facilities across 23 districts, with 99 facilities randomly selected to receive access to bi-directional drones in addition to traditional transportation methods, while 110 facilities serve as the control group, continuing to rely solely on traditional means of transport. Baseline data collection has been completed, and endline data collection is planned to start approximately six months after the last facility gains access to drone flights. The endline measurements will rely on digitisation of paper records collected directly from facilities as well as interviews with health worker staff. The evaluation objectives encompass both supply chain outcomes (on tracer products consisting of medicines, vaccines, and rapid diagnostic tests) and proxy health outcomes (vaccinations and patient referrals due to stockouts), serving as the main indicators to determine the success of the intervention.

We conduct power calculations using the baseline data and find the evaluation is powered to detect reasonable effect sizes on supply chain indicators and health proxies.

Baseline results:

The randomization produced a well-balanced sample. The sampled health facilities predominantly consist of government-run facilities and are small health centres. These facilities are situated in truly remote areas, with an average travel time of 81 minutes by car to reach the nearest paved road.

The selected tracer products for the evaluation are typically stocked in these facilities, indicating that the tracer list represents products relevant for the vast majority of health centres. However, stockouts are a significant issue, with facilities reporting shortages of medical products between 6-20% of the time. This results in 8-13% of patients being referred to other facilities due to product stockouts. This imposes both financial and health burden on patients who are already likely experiencing weakened health due to their symptoms. Moreover, the turnaround time for lab samples is currently high; it takes about 38 days for the facilities to receive lab results from the time of sample collection, which can be a significant public health concern especially for contagious diseases. These findings highlight the potential for bidirectional drones to significantly improve healthcare delivery and positively impact the overall efficiency of the health system.