At the Crossroads for the Use of Drones in Public Health System in India: Leveraging Community Mobilisation

Abstract

Unmanned Aerial Vehicles (UAVs) hold promise for transforming healthcare delivery, offering rapid and cost-effective solutions for transporting medical supplies, especially in difficult terrains. However, their successful adoption within public health systems requires careful consideration of community factors. This viewpoint emphasizes the critical role of community mobilization in fostering a robust and sustainable drone ecosystem for healthcare. Leveraging grassroot governance and community engagement is crucial for bridging the gap between technology and the public. Community members can provide valuable insights into local needs and ensure the safe and efficient drone operations. Moreover, community involvement, from planning to monitoring, ensures that drone services are culturally sensitive, address local needs, and promote trust. Thus, a community-centric approach not only enhances healthcare delivery but also addresses safety concerns and promotes the long-term sustainability of drone-based healthcare solutions, bringing us closer to achieving “Health for All”.

INTRODUCTION

Unmanned Aerial Vehicles (UAVs) or drones have proliferated in recent years as they can traverse through difficult terrain, reduce labor costs, and replace vehicles’ fleets.[1] They have been used for surveillance and humanitarian aid delivery and are now being developed to transport medical samples and supplies.[2] In healthcare sector, timely delivery of medical supplies is essential, which is often hampered by numerous factors such as, poor transportation networks, traffic and adverse environmental conditions. Drones’ have been explored for their rapid, cost-effective and safe delivery of medical supplies.[3,4] Drones present substantial opportunities in healthcare, such as mapping the spread of infectious diseases, carrying out search and rescue operations in challenging environments, and transporting medical supplies to remote locations.[5] During the COVID-19 crisis, drones showcased their capability to tackle challenges associated with delivering medical supplies. As part of the Indian Council of Medical Research (ICMR) initiative, drones were deployed to transport critical medical resources like blood units and vaccines. The ICMR Drone Response and Outreach for Northeast (I-Drone) project launched on October 04, 2021, with a strategic focus on enhancing emergency medical services and healthcare delivery in the challenging North Eastern region’s complex geographical terrain.[6] Recently, the use of drones in the healthcare sector also gained high attention for the delivery of vaccines or medicine, blood products, hazardous materials, diagnostics, organ transfers, and the transfer of small medical or surgical devices.[7,8] Transportation of blood, vaccine, biological samples through roads requires adequate temperature conditions, and the prevailing road conditions in developing countries may not be conducive.[5] Despite the growing interest and advantages of the technology, drones are far from being incorporated into the public healthcare system. This paper explores the community participation and engagement frameworks and collaborative approaches for effectively integrating drone technology within India’s public health infrastructure.

The use of drones can leapfrog the geographical hurdles and help in last-mile delivery of medical logistics in remotely located and in disaster situations when the land routes are cut-off.[9] Healthcare drone operations in the Beyond Visual Line of Sight (BVLOS) category present significant challenges and demand more stringent performance standards compared to Visual Line of Sight (VLOS) drones used in agriculture. This complexity is partly due to BVLOS drones necessitating a wider operational area, further intensifying the technical and regulatory requirements in the healthcare sector. However, the BVLOS operations pose significant risks and safety concerns to the community and local residents in the area of operations. Moreover, the acceptability of drone technology needs to be considered, particularly in places where people have limited exposure to drone technology.[10] In an era where technology serves as a cornerstone for advancing healthcare delivery, the integration of drone technology with community-driven efforts presents an unprecedented opportunity to revolutionize the accessibility and efficiency of health services. The community awareness initiative typically involves a physical demonstration of a drone, along with Information, Education, and Communication (IEC) regarding its benefits and risks, as well as a demonstration of flight operations. Understanding community perceptions is crucial in identifying challenges and opportunities of drone acceptability and developing an evidence-based community mobilization strategy.[10] Moreover, the process brings inclusiveness, dispels myths and fills the knowledge gap in the community. The synergy between drones and community-centric models has the potential to enhance health service delivery and foster a more robust drone ecosystem tailored to the specific health needs of diverse populations.

SYNERGY BETWEEN COMMUNITY MOBILIZATION AND DRONE OPERATIONS

In rural India, local governing bodies are essential for attaining sustainable development goals and executing public programs at the community level.[11,12] Traditionally in India, the panchayat is the council of members looking after the local governance issue at the village level. The panchayats are the functional institutions of grassroots governance. Currently, the Panchayati Raj Institutions (PRI) involvement is important to reach the underprivileged and vulnerable—especially women, children, and the impoverished—and obtain widespread community participation. In the primary health centers and sub centers, the Jan Arogya Samiti (JAS) serves as an institutional platform for community participation in the management, supervision, and upholding of healthcare service responsibility.[13,14]

The JAS serve as an institutional platform at the Sub Health Center and Primary health center level in both rural and urban areas, for community participation in its management, governance and ensuring accountability, with respect to the provision of healthcare services and amenities.[12] The JAS acts as an umbrella organization, offering mentorship for health promotion and action on social and environmental determinants of health in community-level national health program activities and other community initiatives. They also assist the Ayushman Bharat-Health and Wellness Centre (AB-HWC) team in their work with Village Health Sanitation Nutrition Committee (VHSNCs) or Mahila Aarogya Samiti (MAS). Along with acting as a Grievance Redressal Platform for the beneficiaries availing services at the healthcare facility, JAS also supports the implementation of social accountability-related activities at healthcare facility in collaboration with VHSNCs/MAS, thus ensuring accessibility and accountability for high-quality services. JAS assists the local Gram Panchayats and Urban Local Bodies (ULBs) in carrying out health planning. Further, utilizing the organized volunteer base that is already in place (National Service Scheme -NSS, National Cadet Corps- NCC, Red Cross, Scouts and Guides, Youth groups, etc.) for patient follow-up, counselling, community mobilization, survey administration, and other relevant tasks. Also, the JAS members are involved in identifying gaps related to physical infrastructure, services (essential and desirable), human resources (HR), equipment, drugs and diagnostics at the healthcare facility based on the standards prescribed. Overall, the activities of JAS are categorized under four main themes: ensuring quality of service delivery, health promotion, grievance redressal, and social accountability. Each theme plays a significant role in the operational effectiveness and community integration of JAS.[12] These activities help in identifying and firming up use cases for drone-based healthcare logistics and moreover, generate awareness among the local community for safe and sustainable drone operations in the vicinity.

The integration of drone services with JAS involves a strategic approach that begins with understanding the specific healthcare needs of the community. Community involvement is pivotal in the successful integration of drone technologies with JAS. Engaging community members not only fosters trust but also ensures that the drone services are tailored to meet the specific needs of the community.[15] Involvement ranges from the planning phase to the operational phase of drone services. Community members can provide valuable insights into local geography, healthcare challenges, and cultural considerations, which are crucial for optimizing drone flight routes and services. Moreover, involving community members in the monitoring and evaluation of drone services will ensure that the services are continuously improved and aligned with community needs.

To ensure the sustainability and effectiveness of drone services, a robust monitoring and evaluation framework is necessary. This framework should include metrics to assess the impact of drone services on healthcare delivery and community well-being. Regular feedback from community members and healthcare workers can provide insights into areas for improvement and help measure the success of the integration efforts. Monitoring and evaluation also involve assessing the safety, efficiency, and reliability of drone operations. This includes tracking the timeliness of deliveries, the condition of medical supplies upon arrival, and the overall satisfaction of healthcare providers and patients with the drone services. By continuously analyzing these metrics, JAS can also make informed decisions to enhance the synergy between drone technologies and healthcare services, ultimately leading to improved health outcomes in the community [Figure 1].

Figure 1.

Community-centric approach for sustainable integration of drones into public healthcare system

COMMUNITY PARTICIPATION FOR SAFE DRONE OPERATIONS

Safety remains a paramount concern when deploying drones in healthcare settings. The BVLOS drone operations are prone to adverse events such as system failure or incremental weather conditions during flight operations. Weather is an important and poorly resolved factor that affects the drone-based delivery of medical supplies. In case of an adverse event (drone crash or potential misuse of drone technology), local community support is essential in successfully retrieving of the drone or raising alerts of any illicit activity.[10] This collaborative approach will help establish a framework that supports the safe and efficient use of drones in healthcare settings.

ENGAGING FEMALE VOLUNTEERS FROM SELF-HELP GROUPS (SHGS)

Engaging female volunteers from self-help groups (SHGs) for healthcare drone operations in remote spoke points is an innovative approach to improve healthcare delivery in underserved areas. Female volunteers from self-help groups have strong connections within their communities, which can enhance coordination and foster greater acceptance of drone operations. While commendable progress has been made in training female volunteers under the “Drone Didi” initiative. The remote pilot training of the female volunteers from SHGs, enabled them to proficiently operate drones, thereby achieving financial independence and also contributing to the empowerment of local communities. The integration of drone didi’s in intensified efforts as a bridge between the drone service provider and the healthcare institution. By involving local volunteers, the drone delivery system can be more responsive to community needs, ensuring timely delivery of essential medical supplies.

CONCLUSION AND WAY FORWARD

Drones are increasingly becoming a popular tool in the healthcare industry. As drone technology and the drone ecosystem continue to evolve, it is important to conduct research studies to evaluate their challenges/barriers in the healthcare sector. Exploring intersectoral synergies can unveils a transformative potential in delivering healthcare services and pave the way for holistic development, thus improving healthcare outcomes in hard-to-reach areas in the country. The path forward demands strategic partnerships, continuous monitoring, and an adaptable framework to navigate the complexities of regulation and technology integration.

Sensitization of the local community through local bodies where drone operations are essential in ensuring safe drone operations in the regions. Also, accountability, acceptability and ownership are crucial for the sustainability of the healthcare drone ecosystem. As we move forward, it is imperative to build on these foundational efforts and continue exploring avenues for research, development, and collaboration to fully realize the potential of drones in revolutionizing healthcare access and delivery. Thus, steadfastly incorporating drone technology into the public healthcare system we bring ourselves closer to our long-term goal “Health for All.”

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.